国际口腔医学杂志 ›› 2017, Vol. 44 ›› Issue (4): 398-404.doi: 10.7518/gjkq.2017.04.007
宋蕾, 姜舒原, 贾仲林, 石冰, 龚彩霞, 李杨
Song Lei, Jiang Shuyuan, Jia Zhonglin, Shi Bing, Gong Caixia, Li Yang
摘要: 目的 研究唇腭裂患儿术前轻度上呼吸道感染相关症状对术后生命体征的影响,从而探寻能反映手术风险的术前指标。方法 查阅唇腭裂手术患儿的病历1 000份,记录患儿术前5项上呼吸道感染相关症状和术后5项生命体征值,进行描述性和单因素统计学分析,探究两者联系。结果 在术后24 h内,93.3%的患儿出现了生命体征异常,但大部分为轻微异常;术前最高体温正常与否的两组间,术后体温和收缩压异常的比例有统计学差异(P< 0.05)。单因素分析显示,术前白细胞计数过高或发热的患儿组与对照组相比,术后呼吸频率的差异有统计学意义(P<0.05);术前发热的患儿组与对照组相比,术后体温和收缩压的差异有统计学意义(P<0.05);术前诊断有上呼吸道感染的患儿组与对照组相比,术后收缩压和血氧饱和度的差异有统计学意义(P<0.05);术前白细胞计数过高的患儿组与对照组相比,术后收缩压的差异有统计学意义(P<0.05)。结论 合并轻度上呼吸道感染的患儿实施全身麻醉下唇腭裂手术是相对安全的,但需加强监护。术前发热是术后生命体征异常的敏感指标,白细胞数和上呼吸道感染诊断亦有一定价值。
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[1] Elwood T, Bailey K. The pediatric patient and upper respiratory infections[J]. Best Pract Res Clin Anaes-thesiol, 2005, 19(1):35-46. [2] 吕玮. 浅谈上呼吸道感染的诊断和合理治疗[J]. 中国全科医学: 医生读者版, 2010(5):24-26. Lü W. A brief talk about diagnosis and rational the-rapy of upper respiratory infection[J]. Chin Gen Pract, 2010(5):24-26. [3] Stasic AF. Perioperative implications of common respiratory problems[J]. Semin Pediatr Surg, 2004, 13(3):174-180. [4] Takemura H, Yasumoto K, Toi T, et al. Correlation of cleft type with incidence of perioperative re-spiratory complications in infants with cleft lip and palate[J]. Paediatr Anaesth, 2002, 12(7):585-588. [5] 李娟, 朱昭琼, 刘德行, 等. 不同年龄段合并轻中度上呼吸道感染患儿全身麻醉的安全性评估[J]. 实用医学杂志, 2014, 30(2):241-243. Li J, Zhu ZQ, Liu DX, et al. The security assessment of general anesthesia in different age groups children with mild to moderate upper respiratory tract infection[J]. J Pract Med, 2014, 30(2):241-243. [6] Duggan M, Kavanagh BP. Perioperative modifications of respiratory function[J]. Best Pract Res Clin An-aesthesiol, 2010, 24(2):145-155. [7] Bhatia N, Barber N. Dilemmas in the preoperative assessment of children[J]. Bja Ceaccp, 2011, 11(6): 214-218. [8] von Ungern-Sternberg BS, Boda K, Chambers NA, et al. Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study [J]. Lancet, 2010, 376(9743):773-783. [9] Garcia-Miguel FJ, Serrano-Aguilar PG, Lopez-Bas-tida J. Preoperative assessment[J]. Lancet, 2003, 362(9397):1749-1757. [10] Gonzalez LP, Pignaton W, Kusano PS, et al. Anes-thesia-related mortality in pediatric patients: a sys-tematic review[J]. Clinics(Sao Paulo), 2012, 67(4): 381-387. [11] Tait AR, Reynolds PI, Gutstein HB. Factors that influence an anesthesiologist’s decision to cancel elective surgery for the child with an upper respira-tory tract infection[J]. J Clin Anesth, 1995, 7(6):491- 499. [12] Harris PA, Oliver NK, Slater P, et al. Safety of neo-natal cleft lip repair[J]. J Plast Surg Hand Surg, 2010, 44(4/5):231-236. [13] Kwari DY, Chinda JY, Olasoji HO, et al. Cleft lip and palate surgery in children: anaesthetic conside-rations[J]. Afr J Paediatr Surg, 2010, 7(3):174-177. [14] Rolf N, Coté CJ. Frequency and severity of desa-turation events during general anesthesia in children with and without upper respiratory infections[J]. J Clin Anesth, 1992, 4(3):200-203. [15] Buhre W, Rossaint R. Perioperative management and monitoring in anaesthesia[J]. Lancet, 2003, 362 (9398):1839-1846. [16] Milić M, Goranović T, Knezević P. Complications of sevoflurane-fentanyl versus midazolam-fentanyl anesthesia in pediatric cleft lip and palate surgery: a randomized comparison study[J]. Int J Oral Maxil-lofac Surg, 2010, 39(1):5-9. [17] Short JA, Owen J. Preoperative assessment and pre-paration for anaesthesia in children[J]. Anaesth Int Care Med, 2012, 13(9):417-423. [18] Darlong V, Khanna P, Baidya DK, et al. Perioperative complications of cochlear implant surgery in children [J]. J Anesth, 2015, 29(1):126-130. [19] Hoffman GM. Outcomes of pediatric anesthesia[J]. Semin Pediatr Surg, 2008, 17(2):141-151. [20] Craig SK, Atkinson D. Pathophysiology of respira-tory disease and its significance to anaesthesia[J]. Anaesth Int Care Med, 2010, 11(10):397-402. [21] Lerman J. Perioperative respiratory complications in children[J]. Lancet, 2010, 376(9743):745-746. [22] Weinberg AC, Huang L, Jiang H, et al. Perioperative risk factors for major complications in pediatric sur-gery: a study in surgical risk assessment for children [J]. J Am Coll Surg, 2011, 212(5):768-778. |
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