Fischer Miloš, Horn Iris-Susanne, Quante Mirja, Merkenschlager Andreas, Schnoor Jörg, Kaisers Udo X, Dietz Andreas, Kluba Karsten
Department of ORL-HNS, University Hospital Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany,
Eur Arch Otorhinolaryngol. 2014 Aug;271(8):2317-24. doi: 10.1007/s00405-014-2956-z. Epub 2014 Mar 11.
Children with certain risk factors, such as comorbidities or severe obstructive sleep apnea syndrome (OSAS) are known to require extended postoperative monitoring after adenotonsillectomy. However, there are no recommendations available for diode-laser-assisted tonsillotomy. A retrospective chart review of 96 children who underwent diode-laser-assisted tonsillotomy (07/2011-06/2013) was performed. Data for general and sleep apnea history, power of the applied diode-laser (λ = 940 nm), anesthesia parameters, the presence of postoperative respiratory complications and postoperative healing were evaluated. After initially uncomplicated diode-laser-assisted tonsillotomy, an adjustment of post-anesthesia care was necessary in 16 of 96 patients due to respiratory failure. Respiratory complications were more frequent in younger children (3.1 vs. 4.0 years, p = 0.049, 95 % CI -1.7952 to -0.0048) and in children who suffered from nocturnal apneas (OR = 5.00, p < 0.01, 95 % CI 1.4780-16.9152) or who suffered from relevant comorbidities (OR = 4.84, p < 0.01, 95 % CI 1.5202-15.4091). Moreover, a diode-laser power higher than 13 W could be identified as a risk factor for the occurrence of a postoperative oropharyngeal edema (OR = 3.45, p < 0.01, 95 % CI 1.3924-8.5602). Postoperative respiratory complications should not be underestimated in children with sleep-disordered breathing (SDB). Therefore, children with SDB, children with comorbidities or children younger than 3 years should be considered "at risk" and children with confirmed moderate to severe OSAS should be referred to a PICU following diode-laser-assisted tonsillotomy. We recommend a reduced diode-laser power (<13 W) to reduce oropharyngeal edema.
已知患有某些风险因素（如合并症或重度阻塞性睡眠呼吸暂停综合征（OSAS））的儿童在腺样体扁桃体切除术后需要延长术后监测时间。然而，对于二极管激光辅助扁桃体切除术尚无可用的推荐意见。我们对96例行二极管激光辅助扁桃体切除术的儿童（2011年7月至2013年6月）进行了回顾性病历审查。评估了一般情况和睡眠呼吸暂停病史、所用二极管激光（λ = 940 nm）的功率、麻醉参数、术后呼吸并发症的发生情况以及术后愈合情况。在最初二极管激光辅助扁桃体切除术无并发症的情况下，96例患者中有16例因呼吸衰竭而需要调整麻醉后护理。呼吸并发症在年幼儿童中更常见（3.1岁对4.0岁，p = 0.049，95%可信区间 -1.7952至 -0.0048），以及在患有夜间呼吸暂停的儿童中（比值比 = 5.00，p < 0.01，95%可信区间1.4780 - 16.9152）或患有相关合并症的儿童中（比值比 = 4.84，p < 0.01，95%可信区间1.5202 - 15.4091）。此外，二极管激光功率高于13 W可被确定为术后口咽水肿发生的危险因素（比值比 = 3.45，p < 0.01，95%可信区间1.3924 - 8.5602）。睡眠呼吸障碍（SDB）儿童术后呼吸并发症不应被低估。因此，SDB儿童、合并症儿童或3岁以下儿童应被视为“高危”，确诊为中度至重度OSAS的儿童在二极管激光辅助扁桃体切除术后应转入儿科重症监护病房（PICU）。我们建议降低二极管激光功率（<13 W）以减少口咽水肿。
