小儿气道异物取出术中及术后发生去氧饱和的危险因素

Risk factors for oxygen desaturation during and after tracheobronchial foreign body removal in children

目的筛选小儿气道异物取出术中及术后发生去氧饱和的危险因素。方法选择2007年2月至2008年10月就诊于本院的气道异物患儿301例，年龄5月～12岁，ASA I或Ⅱ级，记录患儿术前合并症情况、异物留存时间、异物种类、异物位置、通气方式、置入硬支气管镜时体动反应的发生情况、术后喉痉挛的发生情况、手术时间、拔管时麻醉深度、苏醒时间及术中、术后去氧饱和的发生情况。脉搏血氧饱和度〈90％并超过58定义为发生去氧饱和。采用logistic回归分析筛选术中及术后发生去氧饱和的危险因素。结果术中去氧饱和的发生率为20．4％，术后去氧饱和的发生率为12．2％。logistic回归分析结果显示术前合并肺炎、异物种类为植物种子类、手术时间〉20min、保留自主呼吸的通气方式是患儿术中发生去氧饱和的危险因素；异物种类为植物种子类及苏醒时间延长是患儿术后发生去氧饱和的危险因素。结论术前合并肺炎、异物种类为植物种子类、手术时间〉20min、保留自主呼吸的通气方式是患儿术中发生去氧饱和的危险因素；异物种类为植物种子类及苏醒时间延长是患儿术后发生去氧饱和的危险因素。

Objective To determine the risk factors for oxygen desaturation during and after tracheobronchial foreign body removal in children. Methods Three hundred and one emergency airway foreign body （FB） removals were performed in children from February 2007 to October 2008. Predictive factors for the development of O2 desaturation during and after operation were analyzed. O2 desaturation was defined as SpO2 〈 90% and the time 〉 5 s. Preoperative complications, persistence, type and location of FB, ventilation mode, body movement at the insertion of bronchoscope, the depth of anesthesia at withdrawal of bronchoscope, duration of operation, duration of emergence phase, occurrence of postoperative laryngospasm and intra- and postoperative O2 desaturation were recorded. Univariate analysis and multivariate logistic regression analysis were used to examine the relationship between these factors and intra-and postoperative O2 desaturation. Results The incidence of O2 desaturation was 20.4% and 12.2 % during and after the procedure respectively. Multivariate logistic regression analysis identified that preoperative pneumonia, ventilation mode, the type of FB and duration of operation were significant predictors for intraoperative O2 desaturation while the type of FB and duration of emergence phase were the significant predictors for postoperative O2 desaturation. Conclusion Preoperative pneumonia, ventilation mode, the type of FB and duration of operation were significant predictors for intraoperative O2 desaturation while the type of FB and duration of emergence phase were the significant predictors tot postoperative O2 desaturation.