Yuki Emi, Soriano Sulpicio G, Shibamura-Fujiogi Miho, Yuki Koichi
University of Michigan, Ann Arbor, MI, USA.
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
Perioper Care Oper Room Manag. 2025 Sep;40. doi: 10.1016/j.pcorm.2025.100510. Epub 2025 Jun 18.
Postoperative pulmonary complications including atelectasis are common complications after surgery. However, the incidence of postoperative atelectasis in pediatric surgical population is not yet well delineated.
Using electronic medical record, we identified pediatric patients who underwent gastrointestinal surgery from January 2016 to September 2019 and determined the presence or absence of postoperative atelectasis by postoperative X-ray read. Risk factor analysis of postoperative atelectasis was performed using logistic regression analysis.
We found that 25.6 % of patients had radiographic evidence of postoperative atelectasis. Univariate and multivariate analyses demonstrated that the risk factors included lower weight, higher ASA class, emergency surgery, the use of higher peak airway pressure, lower lung compliance, and the lack of neuromuscular relaxant reversal agent use. In patients who received muscle relaxants, the lack of neuromuscular relaxant reversal agent use was associated with an increased risk of postoperative atelectasis (odds ratio 0.421, 95 % confidence interval 0.235-0.723, < 0.001).
Postoperative atelectasis was frequently observed in pediatric patients undergoing gastrointestinal surgery. For cases where neuromuscular blockade is used, adequate reversal is critical.
包括肺不张在内的术后肺部并发症是手术后常见的并发症。然而，小儿外科患者术后肺不张的发生率尚未得到明确界定。
利用电子病历，我们确定了2016年1月至2019年9月期间接受胃肠道手术的儿科患者，并通过术后X线读片确定是否存在术后肺不张。采用逻辑回归分析对术后肺不张的危险因素进行分析。
我们发现25.6%的患者有术后肺不张的影像学证据。单因素和多因素分析表明，危险因素包括体重较低、美国麻醉医师协会（ASA）分级较高、急诊手术、使用较高的气道峰压、较低的肺顺应性以及未使用神经肌肉阻滞剂逆转剂。在接受肌肉松弛剂的患者中，未使用神经肌肉阻滞剂逆转剂与术后肺不张风险增加相关（比值比0.421，95%置信区间0.235 - 0.723，P<0.001）。
在接受胃肠道手术的儿科患者中经常观察到术后肺不张。对于使用神经肌肉阻滞的病例，充分的逆转至关重要。
