Department of Anaesthesia, Intensive care and Pain Management, Robert Debré University Hospital, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France.
Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France; Department of Ent-Nose and Throat Surgery, Robert Debré University Hospital, AP-HP, 75019 Paris, France; UMR Inserm U 676, Robert Debré University Hospital, 75019 Paris, France.
Anaesth Crit Care Pain Med. 2018 Oct;37(5):439-445. doi: 10.1016/j.accpm.2017.09.002. Epub 2017 Oct 12.
Tonsillectomy is considered as a therapeutic option in obstructive sleep apnoea syndrome (OSAS). Postoperative respiratory failure is a complication that can require respiratory support. The main objective of our study is to determine risk factors of postoperative respiratory complications in children undergoing tonsillectomy.
This is a retrospective single centre observational study including patients with unanticipated postoperative respiratory failure. Patients with a planned preoperative intensive care admission were excluded (age is lower than 2 years, overweight (>95% percentile of BMI), moderate or severe asthma, major medical conditions). Those patients were compared with randomly selected control patients. Factors studied were: age, weight, indication of surgery, ASA status, preoperative illness conditions, durations of surgery and anaesthesia and administered medications. Statistics used a univariate analysis and a multivariate logistic regression.
Eight hundred and five patients underwent adenotonsillectomy during the study period and 25 developed postoperative respiratory failure. These patients were compared to 103 non-complicated control patients. Age (<4 years), weight (<18kg), indication of surgery (as SOAS), laryngomalacia, stable and minor congenital cardiac malformation and duration of anaesthesia were found statistically associated. Multivariate analysis found that weight <18kg is a risk factor associated with the occurrence of postoperative respiratory failure. Overall the model shows a strong accuracy with an area under the curve of ROC analysis of 0.9 [95% confidence interval: 0.85-0.95].
Our study found that weight <18kg is a major risk factor for predicting a postoperative respiratory complication.
扁桃体切除术被认为是阻塞性睡眠呼吸暂停综合征（OSAS）的一种治疗选择。术后呼吸衰竭是一种可能需要呼吸支持的并发症。我们研究的主要目的是确定行扁桃体切除术的儿童术后呼吸并发症的危险因素。
这是一项回顾性单中心观察研究，包括术后发生意外呼吸衰竭的患者。排除了计划术前入住重症监护病房的患者（年龄小于 2 岁、超重（BMI 超过 95%百分位）、中度或重度哮喘、重大医疗状况）。将这些患者与随机选择的对照患者进行比较。研究的因素包括：年龄、体重、手术指征、ASA 状态、术前疾病状况、手术和麻醉持续时间以及给予的药物。统计学使用单变量分析和多变量逻辑回归。
在研究期间，805 例患者行腺样体扁桃体切除术，25 例发生术后呼吸衰竭。这些患者与 103 例无并发症的对照患者进行了比较。年龄（<4 岁）、体重（<18kg）、手术指征（作为 SOAS）、喉软骨软化、稳定和轻微先天性心脏畸形以及麻醉持续时间与统计学相关。多变量分析发现，体重<18kg 是与术后呼吸衰竭发生相关的危险因素。总体而言，该模型的 ROC 分析曲线下面积为 0.9 [95%置信区间：0.85-0.95]，显示出很强的准确性。
我们的研究发现，体重<18kg 是预测术后呼吸并发症的一个主要危险因素。
