中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2014年
11期
925-929
,共5页
王素芳%韩富根%成怡冰%僧东杰
王素芳%韓富根%成怡冰%僧東傑
왕소방%한부근%성이빙%승동걸
异物%气管疾病%儿童%呼吸功能不全%急性病%危险因素
異物%氣管疾病%兒童%呼吸功能不全%急性病%危險因素
이물%기관질병%인동%호흡공능불전%급성병%위험인소
Foreign bodies%Tracheal diseases%Child%Respiratory insufficiency%Acute disease%Risk factors
目的 分析小儿呼吸道异物取出术前发生急性呼吸功能不全(acute respiratory dysfunction,ARD)的相关危险因素,为临床预防和治疗提供依据.方法 采用整群抽样的方法收集2009年7月至2012年12月456例呼吸道异物患儿临床资料,男246例,女210例;年龄0.5～11岁;发病到就诊时间0.15～14 d.记录患儿年龄、性别、既往史、异物史、异物种类、异物部位,是否合并发热、肺炎、纵隔或皮下积气等.监测患儿术前体温、呼吸频率、心率、紫绀情况,经皮氧饱和度(transcutaneous oxygen saturation)和(或)血气分析.对可能引起ARD发生的因素采用二分类进行单因素分析和多因素Logistic逐步回归分析.结果 78例(17.1％)异物取出术前发生ARD.456例患儿中455例一次手术成功,1例由气管镜手术转至胸外科开胸取出异物.452例患儿术后4～6h拔管撤机,ARD组有2例2～4d后拔管撤机,2例合并重症肺炎患儿死亡.经卡方检验发现,ARD组和非ARD组患几年龄,异物部位,体温,是否合并肺炎、纵隔或皮下积气是发生ARD的影响因素(P值均＜0.05).多因素Logistic回归分析结果显示,异物位于主气管或双侧支气管、合并肺炎、合并纵隔或皮下积气是小儿呼吸道异物发生ARD的独立危险因素(P值均＜0.05).结论 通过早期判断小儿呼吸道异物发生ARD的危险因素,可为临床进行手术及围手术期处理提供参考依据.
目的 分析小兒呼吸道異物取齣術前髮生急性呼吸功能不全(acute respiratory dysfunction,ARD)的相關危險因素,為臨床預防和治療提供依據.方法 採用整群抽樣的方法收集2009年7月至2012年12月456例呼吸道異物患兒臨床資料,男246例,女210例;年齡0.5～11歲;髮病到就診時間0.15～14 d.記錄患兒年齡、性彆、既往史、異物史、異物種類、異物部位,是否閤併髮熱、肺炎、縱隔或皮下積氣等.鑑測患兒術前體溫、呼吸頻率、心率、紫紺情況,經皮氧飽和度(transcutaneous oxygen saturation)和(或)血氣分析.對可能引起ARD髮生的因素採用二分類進行單因素分析和多因素Logistic逐步迴歸分析.結果 78例(17.1％)異物取齣術前髮生ARD.456例患兒中455例一次手術成功,1例由氣管鏡手術轉至胸外科開胸取齣異物.452例患兒術後4～6h拔管撤機,ARD組有2例2～4d後拔管撤機,2例閤併重癥肺炎患兒死亡.經卡方檢驗髮現,ARD組和非ARD組患幾年齡,異物部位,體溫,是否閤併肺炎、縱隔或皮下積氣是髮生ARD的影響因素(P值均＜0.05).多因素Logistic迴歸分析結果顯示,異物位于主氣管或雙側支氣管、閤併肺炎、閤併縱隔或皮下積氣是小兒呼吸道異物髮生ARD的獨立危險因素(P值均＜0.05).結論 通過早期判斷小兒呼吸道異物髮生ARD的危險因素,可為臨床進行手術及圍手術期處理提供參攷依據.
목적 분석소인호흡도이물취출술전발생급성호흡공능불전(acute respiratory dysfunction,ARD)적상관위험인소,위림상예방화치료제공의거.방법 채용정군추양적방법수집2009년7월지2012년12월456례호흡도이물환인림상자료,남246례,녀210례;년령0.5～11세;발병도취진시간0.15～14 d.기록환인년령、성별、기왕사、이물사、이물충류、이물부위,시부합병발열、폐염、종격혹피하적기등.감측환인술전체온、호흡빈솔、심솔、자감정황,경피양포화도(transcutaneous oxygen saturation)화(혹)혈기분석.대가능인기ARD발생적인소채용이분류진행단인소분석화다인소Logistic축보회귀분석.결과 78례(17.1％)이물취출술전발생ARD.456례환인중455례일차수술성공,1례유기관경수술전지흉외과개흉취출이물.452례환인술후4～6h발관철궤,ARD조유2례2～4d후발관철궤,2례합병중증폐염환인사망.경잡방검험발현,ARD조화비ARD조환궤년령,이물부위,체온,시부합병폐염、종격혹피하적기시발생ARD적영향인소(P치균＜0.05).다인소Logistic회귀분석결과현시,이물위우주기관혹쌍측지기관、합병폐염、합병종격혹피하적기시소인호흡도이물발생ARD적독립위험인소(P치균＜0.05).결론 통과조기판단소인호흡도이물발생ARD적위험인소,가위림상진행수술급위수술기처리제공삼고의거.
Objective This study aims to analyze the independent risk factors of acute respiratory dysfunction (ARD) in children with airway foreign body and to assess possible prevention and treatment option in the future.Methods Clinical data of 456 cases of children with airway foreign body were retrospectively collected and analyzed by cluster sampling,including 246 males and 210 females,who received operation in our hospital between July,2009 and December,2012,aged 0.5-11 years old,onset to treatment time was 0.15-14 days.Chnical characteristics including age,gender,past medical history,time of onset,temperature,location of the foreign body,category of foreign bodies,complicated by pneumonia,complicated by subcutaneous and mediastinal emphysema were gathered.Temperature,respiratory rate,heart rate,cyanosis,transcutaneous oxygen saturation or arterial blood analysis were assayed before operation.Risk factors with statistical significance were screened with univariate logistic regression analysis,independent risk factors of ARD were determined with multivariate logistic regression analysis.Results Acute respiratory dysfunction occurred in 78 (17.1％) patients.The foreign bodies in 455cases were successfully removed brocboscopically in the first time.One case received chest surgery for foreign body removal.Total of 452 cases were successfully extubated and ventilator weaned 4-6 h after brochoscopy.In 2 cases,the ventilator was weaned 2-4 d after brochoscopy in ARD gup,and 2 cases with severe pneumonia died.Age,location of the foreign body,temperature,complicated by pneumonia,complicated by subcutaneous and mediastinal emphysema did not show significant difference between acute respiratory dysfunction group and non-acute respiratory dysfunction group (P ＜ 0.05).Multivariate logistic regression analysis showed location of the foreign body and complicated by pneumonia,complicated by subcutaneous and mediastinal emphysema were independent risk factors for ARD.Conclusion Early judgement of the risk factors of acute respiratory dysfunction in children with airway foreign body can provide a reference for the operation and perioperation period treatment.
