碳氧血红蛋白对小儿扁桃体切除术后并发症及疼痛的影响。

Effect of carboxyhemoglobin on postoperative complications and pain in pediatric tonsillectomy patients.

作者信息

Koyuncu Onur, Turhanoglu Selim, Tuzcu Kasım, Karcıoglu Murat, Davarcı Isil, Akbay Ercan, Cevik Cengiz, Ozer Cahit, Sessler Daniel I, Turan Alparslan

机构信息

Department of Anesthesiology and Department of Outcomes Research, Tayfur Ata Sokmen Medicine Faculty, Mustafa Kemal University, Hatay, Turkey.

出版信息

Paediatr Anaesth. 2015 Mar;25(3):247-52. doi: 10.1111/pan.12531. Epub 2014 Sep 24.

DOI:10.1111/pan.12531

PMID:25251189

Abstract

BACKGROUND

Carbon monoxide (CO) is a product of burning solid fuel in stoves and smoking. Exposure to CO may provoke postoperative complications. Furthermore, there appears to be an association between COHb concentrations and pain. We thus tested the primary hypothesis that children with high preoperative carboxyhemoglobin (COHb) concentrations have more postoperative complications and pain after tonsillectomies, and secondarily that high-COHb concentrations are associated with more pain and analgesic use.

METHODS

100 children scheduled for elective tonsillectomy were divided into low and high carbon monoxide (CO) exposure groups: COHb ≤3 or ≥4 g·dl(-1) . We considered a composite of complications during the 7 days after surgery which included bronchospasm, laryngospasm, persistent coughing, desaturation, re-intubation, hypotension, postoperative bleeding, and reoperation. Pain was evaluated with Wong-Baker Faces pain scales, and supplemental tramadol use recorded for four postoperative hours.

RESULTS

There were 36 patients in the low-exposure group COHb [1.8 ± 1.2 g·dl(-1) ], and 64 patients were in the high-exposure group [6.4 ± 2.1 g·dl(-1) ]. Indoor coal-burning stoves were reported more often by families of the high- than low-COHb children (89% vs 72%, P < 0.001). Second-hand cigarette smoke exposure was reported by 54% of the families with children with high COHb, but only by 24% of the families of children with low COHb. Composite complications were more common in patients with high COHb [47% vs 14%, P = 0.0001, OR:7.4 (95% Cl, lower = 2.5-upper = 21.7)], with most occurring in the postanesthesia care unit. Pain scores in postanesthesia care unit and one hour after surgery were statistically significantly lower in the low-exposure group [respectively, P = 0.020 (95%CI, lower = -1.21-upper = -0.80), P = 0.026 (95% CI, lower = -0.03-upper = 0.70)], and tramadol use increased at 4 h (3.5 (interquartile range: 0-8) vs 6 (5-9) mg, P = 0.012) and 24 h (3.5 (0-8) vs 6 (5-9) mg, P = 0.008).

CONCLUSION

High preoperative COHb concentrations are associated with increased postoperative complications and pain.

摘要

背景

一氧化碳（CO）是炉灶中固体燃料燃烧及吸烟产生的产物。接触CO可能引发术后并发症。此外，碳氧血红蛋白（COHb）浓度与疼痛之间似乎存在关联。因此，我们检验了以下主要假设：术前COHb浓度高的儿童在扁桃体切除术后有更多的术后并发症和疼痛，其次检验了高COHb浓度与更多疼痛及镇痛药物使用相关的假设。

方法

100例计划行择期扁桃体切除术的儿童被分为低一氧化碳（CO）暴露组和高一氧化碳暴露组：COHb≤3或≥4 g·dl⁻¹。我们将术后7天内的并发症综合考虑，包括支气管痉挛、喉痉挛、持续性咳嗽、血氧饱和度下降、再次插管、低血压、术后出血和再次手术。使用面部表情疼痛量表评估疼痛，并记录术后4小时内曲马多的补充使用情况。

结果

低暴露组有36例患者，COHb为[1.8±1.2 g·dl⁻¹]，高暴露组有64例患者，COHb为[6.4±2.1 g·dl⁻¹]。高COHb儿童家庭报告使用室内燃煤炉灶的频率高于低COHb儿童家庭（89%对72%，P<0.001）。54%的高COHb儿童家庭报告有二手烟暴露，而低COHb儿童家庭中只有24%报告有二手烟暴露。高COHb患者的综合并发症更常见[47%对14%，P = 0.0001，OR：7.4（95%CI，下限=2.5 - 上限=21.7）]，大多数发生在麻醉后护理单元。低暴露组在麻醉后护理单元和术后1小时的疼痛评分在统计学上显著更低[分别为，P = 0.020（95%CI，下限=-1.21 - 上限=-0.80），P = 0.026（95%CI，下限=-0.03 - 上限=0.70）]，并且曲马多使用量在4小时（3.5（四分位间距：0 - 8）对6（5 - 9）mg，P = 0.012）和24小时（3.5（0 - 8）对6（5 - 9）mg，P = 0.008）时增加。