Department of Otolaryngology, Heim Pál National Institute of Paediatrics, Budapest, Hungary.
Department of Oto-Rhino-Laryngology and Head-Neck Surgery, University of Szeged, Szeged, Hungary.
Acta Otorhinolaryngol Ital. 2022 Apr;42(2):162-168. doi: 10.14639/0392-100X-N1803.
We aimed to prospectively assess the effect of comorbidities on the occurrence of postoperative respiratory complications (PoRCs) after adenotonsillectomy in children with obstructive sleep apnoea syndrome (OSA) and whether otherwise healthy children need a higher level of postoperative monitoring.
577 children who had OSA and underwent adenotonsillectomy were enrolled. The effects of demographics, comorbidities and OSA on PoRCs were investigated with logistic regression analysis.
The PoRC rate was 4.3%. Postoperative oxygen desaturations were more marked in patients with comorbidities (p = 0.005). The presence of comorbidity increased the risk of PoRCs (odds ratio 4.234/3.226-5.241, 95% confidence intervals, p < 0.001). There was no difference in apnoea-hypopnoea index (AHI) values between comorbid patients with and without PoRCs [8.2 (3.8-50.2) 14.3 (11.7-23.3)]. (p = 0.37). In the group of patients without comorbidities, PoRCs were associated with a higher AHI [14.7 (3.4-51.3) 3.9 (2.0- 8.0), p < 0.001].
Comorbidities are more closely linked with PoRCs than OSA severity. In patients without comorbidity, PoRCs are associated with OSA severity and usually occur within the first 2 hours after the intervention.
本研究旨在前瞻性评估合并症对阻塞性睡眠呼吸暂停综合征（OSA）患儿腺样体扁桃体切除术（adenotonsillectomy）后发生术后呼吸并发症（PoRCs）的影响，以及是否健康的患儿需要更高水平的术后监测。
共纳入 577 例患有 OSA 并接受腺样体扁桃体切除术的儿童。采用逻辑回归分析评估人口统计学、合并症和 OSA 对 PoRCs 的影响。
PoRC 发生率为 4.3%。合并症患者术后血氧饱和度下降更为明显（p = 0.005）。合并症的存在增加了 PoRCs 的风险（优势比 4.234/3.226-5.241，95%置信区间，p < 0.001）。合并症患者中 PoRC 组和无 PoRC 组的呼吸暂停低通气指数（apnoea-hypopnoea index，AHI）值无差异[8.2（3.8-50.2）比 14.3（11.7-23.3），p = 0.37]。在无合并症的患者中，PoRCs 与更高的 AHI 相关[14.7（3.4-51.3）比 3.9（2.0-8.0），p < 0.001]。
与 OSA 严重程度相比，合并症与 PoRCs 的关系更为密切。在无合并症的患者中，PoRCs 与 OSA 严重程度相关，通常发生在干预后的前 2 小时内。
