Martins Renato Oliveira, Castello-Branco Nuria, Barros Jefferson Luis de, Weber Silke Anna Theresa
School of Medicine, São Paulo State University Botucatu, Botucatu, Brazil.
School of Medicine, University of São Paulo, São Paulo, Brazil.
J Bras Pneumol. 2015 May-Jun;41(3):238-45. doi: 10.1590/S1806-37132015000004415. Epub 2015 Apr 18.
To identify risk factors for respiratory complications after adenotonsillectomy in children ≤ 12 years of age with obstructive sleep apnea who were referred to the pediatric ICU (PICU).
A cross-sectional historical cohort study analyzing 53 children after adenotonsillectomy who met predetermined criteria for PICU referral in a tertiary level teaching hospital. The Student's t-test, Mann-Whitney test, and chi-square test were used to identify risk factors.
Of the 805 children undergoing adenotonsillectomy between January of 2006 and December of 2012 in the teaching hospital, 53 were referred to the PICU. Twenty-one children (2.6% of all those undergoing adenotonsillectomy and 39.6% of those who were referred to the PICU) had respiratory complications. Of those 21, 12 were male. The mean age was 5.3 ± 2.6 years. A high apnea-hypopnea index (AHI; p = 0.0269), a high oxygen desaturation index (ODI; p = 0.0082), a low SpO2 nadir (p = 0.0055), prolonged orotracheal intubation (p = 0.0011), and rhinitis (p = 0.0426) were found to be independent predictors of respiratory complications. Some of the complications observed were minor (SpO2 90-80%), whereas others were major (SpO2 ≤ 80%, laryngospasm, bronchospasm, acute pulmonary edema, pneumonia, and apnea).
Among children up to 12 years of age with OSA, those who have a high AHI, a high ODI, a low SpO2 nadir, or rhinitis are more likely to develop respiratory complications after adenotonsillectomy than are those without such characteristics.
确定因阻塞性睡眠呼吸暂停而入住儿科重症监护病房(PICU)的12岁及以下儿童行腺样体扁桃体切除术后发生呼吸并发症的危险因素。
一项横断面历史性队列研究,分析了一家三级教学医院中53例行腺样体扁桃体切除术后符合PICU转诊预定标准的儿童。采用学生t检验、曼-惠特尼检验和卡方检验来确定危险因素。
在2006年1月至2012年12月期间于该教学医院接受腺样体扁桃体切除术的805名儿童中,有53名被转诊至PICU。21名儿童(占所有接受腺样体扁桃体切除术儿童的2.6%,占被转诊至PICU儿童的39.6%)发生了呼吸并发症。在这21名儿童中,12名是男性。平均年龄为5.3±2.6岁。高呼吸暂停低通气指数(AHI;p = 0.0269)、高氧饱和度下降指数(ODI;p = 0.0082)、低最低血氧饱和度(SpO2;p = 0.0055)、口气管插管时间延长(p = 0.0011)和鼻炎(p = 0.0426)被发现是呼吸并发症的独立预测因素。观察到的一些并发症较轻(SpO2为90%-80%),而其他并发症则较严重(SpO2≤80%、喉痉挛、支气管痉挛、急性肺水肿、肺炎和呼吸暂停)。
在12岁及以下患有阻塞性睡眠呼吸暂停的儿童中,与没有这些特征的儿童相比,AHI高、ODI高、最低SpO2低或患有鼻炎的儿童在腺样体扁桃体切除术后更有可能发生呼吸并发症。