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腺样体扁桃体切除术中接受全身麻醉的儿童气道顺应性和阻力的影响因素。

Factors affecting airway compliance and resistance in children receiving general anesthesia during adenotonsillectomy.

作者信息

Li Jingjie, Li Siyuan, Jiang Hong, Jiang Lai, Qiu Lin

机构信息

Department of Anesthesiology, Shanghai Ninth People's Hospital.

Department of Anesthesiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

出版信息

Medicine (Baltimore). 2020 Sep 4;99(36):e22101. doi: 10.1097/MD.0000000000022101.

Abstract

Airway compliance is an important index in the surgery of pediatric patients. This study aimed to explore factors affecting dynamic airway compliance (Cdyn) and airway resistance (Raw) after general anesthesia endotracheal intubation for adenotonsillectomy of pediatric patients.A prospective study was undertaken of 107 children who underwent adenotonsillectomy in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine between January and June 2018. The values of Cdyn and Raw were recorded at 5, 10, and 15 minute during general anesthesia endotracheal intubation. Univariate analysis and multiple linear regression analysis were performed for factors that affected Cdyn and Raw.Of the 107 patients aged 56.67 ± 18.28 months, 69 (64%) patients were male, and 26 (24%) and 12 (11%) had an upper respiratory infection in the past week and 1 to 2 weeks, respectively. During anesthesia, Cdyn showed a decreasing trend (P < .001) while Raw showed an increasing trend (P < .001). Multivariate analysis revealed that height (β=0.177-0.193) had the strongest correlation with Cdyn; rales during pulmonary auscultation (β= -2.727 to -1.363) and sputum suction (β= -1.670 to -0.949) were also associated with Cdyn (all P < .05). Height was the factor with the strongest negative correlation with Raw (β= -0.382 to -0.305). Rales during pulmonary auscultation (β=10.063-11.326) and sputum suction (β=3.863-9.003) were also associated with Raw (All P < .05).Height, rales during preoperative auscultation and sputum suction were all associated with intraoperative Cydn and Raw for pediatric patients undergoing adenotonsillectomy and should be considered before the surgery.

摘要

气道顺应性是小儿患者手术中的一项重要指标。本研究旨在探讨小儿腺样体扁桃体切除术后全身麻醉气管插管后影响动态气道顺应性(Cdyn)和气道阻力(Raw)的因素。

对2018年1月至6月在上海交通大学医学院附属新华医院接受腺样体扁桃体切除术的107例儿童进行了一项前瞻性研究。在全身麻醉气管插管期间的5、10和15分钟记录Cdyn和Raw的值。对影响Cdyn和Raw的因素进行单因素分析和多元线性回归分析。

107例年龄为56.67±18.28个月的患者中,69例(64%)为男性,26例(24%)和12例(11%)分别在过去一周和1至2周内有上呼吸道感染。麻醉期间,Cdyn呈下降趋势(P<0.001),而Raw呈上升趋势(P<0.001)。多因素分析显示,身高(β=0.177 - 0.193)与Cdyn的相关性最强;肺部听诊啰音(β= -2.727至 -1.363)和吸痰(β= -1.670至 -0.949)也与Cdyn相关(均P<0.05)。身高是与Raw负相关性最强的因素(β= -0.382至 -0.305)。肺部听诊啰音(β=10.063 - 11.326)和吸痰(β=3.863 - 9.003)也与Raw相关(均P<0.05)。

身高、术前听诊啰音和吸痰均与接受腺样体扁桃体切除术的小儿患者术中的Cydn和Raw相关,手术前应予以考虑。

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