支气管异物取出术后喉痉挛的多因素分析

Multifactor analysis of laryngospasm after tracheobronchial foreign bodies removal in children

目的分析与小儿支气管异物取出术后喉痉挛发生相关的危险因素。方法对73例气道异物的患儿按照有无喉痉挛对年龄、性别、异物类型、异物存留时间、术前有无肺部感染、手术时间、术中有无缺氧、通气方式、退支气管镜时的麻醉状态进行分析,并进一步做成组资料的Logistic逐步回归法分析与术后喉痉挛相关的因素。结果喉痉挛的发生与异物种类、异物存留时间、患儿术中有无缺氧、退支气管镜时的麻醉状态有关(P值均<0.05)。结论小儿支气管异物取出术后发生喉痉挛与长期吸入植物性异物、术中缺氧及浅麻醉状态下退支气管镜有关。应用激素、术中控制麻醉深度、在深麻醉下或患儿清醒状态下退支气管镜可有效预防术后喉痉挛。

Objective To analyze the risk factors of laryngospasm after tracheobronchial removal of foreign bodies in children. Methods All putative factors, including age, sex, types of foreign body, obstruction with foreign body, presence of lung infection, operation time, presence of hypoxia during operation, ventilation types, and anesthesia status, were studied in 73 children after removal of tracheobronchial foreign bodies. Logistic regression analysis was performed to analyze their relationship with laryngospasm. Results The occurrence of laryngospasm was correlated with the obstruction period, category of foreign bodies, presence of hypoxia during operation and the depth of anesthesia during extubation （all P〈0.05）. Conelusion Laryngospasm after tracheobronchial foreign bodies removal in children is associated with the long time existence of vegetal foreign bodies, the descent of pulse oxygen saturation in Operation and the extubation under shallow anesthesia. Use of glucocorticoid, control of anesthesia depth, and extubation under deep anesthesia or awake condition can effectively prevent laryngospasm after operation.