Postma D S, Poole M D, Wu S M, Tober R
University of North Carolina, Chapel Hill School of Medicine 27599, USA.
Int J Pediatr Otorhinolaryngol. 1997 Sep 18;41(3):253-62. doi: 10.1016/s0165-5876(97)00086-4.
To study the effect of day care and tube type, as well as other risk factors related to ventilation tube insertion and reinsertion.
A case series of 456 consecutive cases with 162 controls from a well-baby examination group evaluated for age, sex, smoking history and day care attendance.
Private practice in a mid-sized, southeastern university town.
This was a referred sample of patients who were entered consecutively in a private-practice setting. All children were age five or less at entry into the study.
Children underwent ventilation tube insertion with or without adenoidectomy, using standing indications.
The primary outcome measures were whether or not a child had the need for a second set of tubes, and also determining the status of the child's ears for at least 1 year after tubes had extruded.
Day care and younger age were both identified as risk factors associated with initial ventilation tube insertion. Only 11% (seven out of 63) of home care children, as compared with 31% (108 out of 346) day care children, had the insertion of ventilation tubes (P = 0.000). Day care children who had tubes inserted and adenoidectomy (with or without tonsillectomy) had a significantly lower rate of reintubation than children who had tube insertion alone (P = 0.00). Day care and young age are significant risk factors for any child, both with a first set of tubes and for ventilation tube reinsertion. Children in day care had a reintubation rate of 36% as compared to 11% for those in home care. Parents should be aware that day care can represent a two-fold hazard both in the observed connection between day care and tube insertion and the demonstrated increased probability of reinsertion. Any studies looking at ventilation tube outcomes need to make certain to monitor for day care attendance.
研究日托和导管类型的影响，以及与通气管插入和再次插入相关的其他风险因素。
对456例连续病例及162例来自健康婴儿检查组的对照进行病例系列研究，评估年龄、性别、吸烟史和日托情况。
东南部一个中等规模大学城镇的私人诊所。
这是一个在私人诊所连续纳入的转诊患者样本。所有儿童在进入研究时年龄均为5岁或更小。
根据既定指征，儿童接受通气管插入术，可伴有或不伴有腺样体切除术。
主要观察指标是儿童是否需要第二套通气管，以及在通气管脱出后至少1年对儿童耳部状况的判定。
日托和年龄较小均被确定为与初次通气管插入相关的风险因素。只有11%（63例中的7例）在家照料的儿童插入了通气管，相比之下，日托儿童中有31%（346例中的108例）插入了通气管（P = 0.000）。接受通气管插入术并进行腺样体切除术（伴或不伴扁桃体切除术）的日托儿童再次插管率显著低于仅接受通气管插入术的儿童（P = 0.00）。日托和年幼是任何儿童首次插入通气管及再次插入通气管的重要风险因素。日托儿童的再次插管率为36%，而在家照料的儿童为11%。家长应意识到，日托在日托与通气管插入之间的观察到的关联以及已证实的再次插入可能性增加方面可能带来双重危害。任何研究通气管结果的研究都需要确保监测日托情况。
