Kendigelen Pinar, Tutuncu Ayse C, Emre Senol, Altindas Fatis, Kaya Guner
Department of Anesthesiology and Intensive Care, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
Department of Pediatric Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
Arch Argent Pediatr. 2018 Apr 1;116(2):98-104. doi: 10.5546/aap.2018.eng.98.
Complications can occur during esophagoscopy as a result of applied procedure in children, especially during dilation techic. Our aim was to identify cardio-respiratory alterations during esophagoscopy with or without baloon dilation under anesthesia in children, and to investigate the postoperative complications.
Prospective, observational study of endoscopic procedures in patients 0-16 years. The patients were divided into two groups: the endoscopy-dilation group (Group ED: endoscopy and balloon dilation due to esophageal stricture) and endoscopy without dilation (Group E: endoscopy for diagnostic reasons, control esophagoscopy or sclerotherapy). Hemodynamic and ventilatory parameters alterations and complications during endoscopy, dilation and two-hours follow-up time in the postoperative recovery room were recorded.
102 procedures in 60 patients were included. Peak inspiratory pressure (PIP) values significantly increased after endoscopy in both groups (p<0.001). There was a significant increase in mean PIP values in the dilation group during the procedure (p<0,001). The difference in PIP values before and after the endoscopy was negatively correlated with age in both groups. When the groups were subdivided taking two years of age as a cut-off point in comparing PIP difference before-after endoscopy, PIP increase was statistically significant in both groups under two-years old. In the dilation group, statistically significant increase of HR was detected during the procedure (p<0,001).
During endoscopy PIP increased in patients with or without baloon dilation especially in the dilation group. PIP increase was higher in younger children. Severe respiratory and cardiovascular complications during balloon dilation under general anesthesia should be carefully observed and managed.
儿童食管镜检查过程中，尤其是扩张技术应用时，可能会出现并发症。我们的目的是确定儿童在麻醉下进行食管镜检查（无论有无球囊扩张）时的心肺改变，并调查术后并发症。
对0至16岁患者的内镜手术进行前瞻性观察研究。患者分为两组：内镜扩张组（ED组：因食管狭窄进行内镜检查和球囊扩张）和非扩张内镜组（E组：出于诊断目的、对照食管镜检查或硬化治疗进行内镜检查）。记录内镜检查、扩张过程中以及术后恢复室两小时随访期间的血流动力学和通气参数改变及并发症。
纳入60例患者的102例手术。两组内镜检查后吸气峰压（PIP）值均显著升高（p<0.001）。扩张组手术过程中平均PIP值显著升高（p<0.001）。两组内镜检查前后PIP值的差异与年龄呈负相关。以两岁为分界点对两组进行细分以比较内镜检查前后的PIP差异时，两岁以下两组的PIP升高均具有统计学意义。在扩张组中，手术过程中检测到心率（HR）有统计学意义的升高（p<0.001）。
无论有无球囊扩张，内镜检查期间患者的PIP均会升高，尤其是扩张组。年幼儿童的PIP升高更明显。全麻下球囊扩张期间应仔细观察和处理严重的呼吸和心血管并发症。
