Allen G S, Cox C S, White N, Khalil S, Rabb M, Lally K P
Department of Surgery, University of Texas, Houston Medical School and the Hermann Children's Hospital, 77030, USA.
J Pediatr Surg. 1998 Jul;33(7):1095-8. doi: 10.1016/s0022-3468(98)90538-3.
BACKGROUND/PURPOSE: The duration of postoperative cardiorespiratory monitoring of premature infants after inguinal herniorrhaphy is uncertain. Prolonged observation requiring hospital admission may be unnecessary and increases costs.
This study was a retrospective review of 191 inguinal herniorrhaphies performed between 1993 and 1996 at the Hermann Children's Hospital. The authors reviewed their experience to identify factors associated with postoperative apnea and bradycardia and determine a safe period of observation.
Among 191 elective inguinal herniorrhaphies performed, 57 (29.8%) were in expremature infants (< or =60 weeks postconception). Five (8.8%) infants either failed extubation or were unable to extubate (group 1). The average age for this group was 41.0 +/- 1.2 weeks compared with 47.2 +/- 1.0 (P = .06) for those who were successfully extubated (group II). Preoperative apnea-bradycardia was found in four (80%) infants in group I compared with 32 (61.5%) in group II (P = 0.67). All group I and 21 (40.4%, P = .09) group II infants with a history of preoperative apnea required intubation for an average of 24.4 +/- 7.8 days and 8.2 +/- 2.4 days, respectively (P = .04). American Society of Anesthesia (ASA) scores were 2.6 +/- 0.4 for group I compared with 1.8 +/- 0.1 for group 11 (P = .01). The use of both intraoperative narcotics (three [60%] in group I v six [12%] in group II, P = .01]) and vecuronium (four [80%] in group I v 16 [31%] in group II, P = .03) were significantly more common in group I infants. Operating room time was 46.4 +/- 4.1 minutes for group I compared with 60.6 +/- 3.9 minutes for group II (P = .27). Postoperative apnea-bradycardia occurred in all five group I infants and two (3.8%, P = .001) group II infants. Group II infants were treated successfully with supplemental oxygen.
All instances of postoperative apnea-bradycardia and laryngospasm occurred within 4 hours after operation without significant differences between groups. The risk of postoperative cardiorespiratory distress requiring reintubation in premature infants who undergo inguinal herniorrhaphy is not insignificant (8.8%). The judicious use of narcotics and vecuronium, and limiting patient selection to those with ASA score of less than 3 may lessen the need for reintubation. When present cardiorespiratory distress occurs early; therefore we recommend outpatient inguinal herniorrhaphy as a safe and cost-effective choice.
背景/目的：腹股沟疝修补术后早产儿心肺监测的时长尚无定论。需要住院进行长时间观察可能并无必要，且会增加费用。
本研究对1993年至1996年在赫尔曼儿童医院进行的191例腹股沟疝修补术进行回顾性分析。作者回顾其经验，以确定与术后呼吸暂停和心动过缓相关的因素，并确定安全的观察期。
在191例择期腹股沟疝修补术中，57例（29.8%）为早产儿（孕龄≤60周）。5例（8.8%）婴儿拔管失败或无法拔管（第1组）。该组婴儿的平均年龄为41.0±1.2周，而成功拔管的婴儿平均年龄为47.2±1.0周（P = 0.06）（第II组）。第1组4例（80%）婴儿术前有呼吸暂停-心动过缓，第II组为32例（61.5%）（P = 0.67）。第1组所有婴儿以及有术前呼吸暂停史的21例（40.4%）第II组婴儿分别平均需要插管24.4±7.8天和8.2±2.4天（P = 0.04）。美国麻醉医师协会（ASA）评分第1组为2.6±0.4，第II组为1.8±0.1（P = 0.01）。术中使用麻醉剂（第1组3例[60%]，第II组6例[12%]，P = 0.01）和维库溴铵（第1组4例[80%]，第II组16例[31%]，P = 0.03）在第1组婴儿中显著更常见。第1组手术室时间为46.4±4.1分钟，第II组为60.6±3.9分钟（P = 0.27）。所有5例第1组婴儿和2例（3.8%，P = 0.001）第II组婴儿术后出现呼吸暂停-心动过缓。第II组婴儿通过补充氧气成功治疗。
所有术后呼吸暂停-心动过缓和喉痉挛病例均发生在术后4小时内，两组间无显著差异。接受腹股沟疝修补术的早产儿术后需要重新插管的心肺窘迫风险并非微不足道（8.8%）。谨慎使用麻醉剂和维库溴铵，并将患者选择限制在ASA评分小于3分的患者，可能会减少重新插管的需求。当出现心肺窘迫时发生较早；因此，我们建议门诊腹股沟疝修补术是一种安全且具有成本效益的选择。
