婴幼儿合并轻度上呼吸道感染择期手术全麻的安全性

The Feasibility and Security of General Anesthesia for Elective Surgery in Infants with Mild Upper Respiratory Tract Infections

目的评估合并轻度上呼吸道感染(URI)的婴幼儿实施全身麻醉的可行性与安全性。方法择期手术插管全身麻醉婴幼儿169例,年龄20 d^36个月、性别不限、ASA分级Ⅰ或Ⅱ级。根据术前是否出现上感症状,将其分为URI组(n=41)和非URI组(n=128)。观察并记录患儿一般情况,手术期、术后呼吸系统相关并发症发生情况。结果 (1)2组间比较:与非URI组相比,URI组在手术期屏气的发生率较高,咳嗽、多痰、血氧饱和度(Sp O2)<0.95、发热、舌后坠发生率差异无统计学意义,2组手术期均无发热。URI组术后多痰的发生率较高,咳嗽、Sp O2<0.95、发热、舌后坠、屏气发生率差异无统计学意义,2组在手术期和术后均未发生喉痉挛与支气管痉挛。(2)手术期-术后比较:与手术期相比,非URI组术后咳嗽、发热的发生率增高,Sp O2<0.95、舌后坠的发生率降低;URI组术后发热的发生率增高,Sp O2<0.95、屏气发生率降低,其余并发症发生率差异无统计学意义。结论合并轻度URI的婴幼儿在周密的术前评估与谨慎的术中管理下实施气管插管全身麻醉是可行并且相对安全的。

Objective To evaluate the feasibility and security of general anesthesia for elective surgery in infants with mild upper respiratory tract infections （URI）. Methods A total of 169 cases of infants underwent general anesthesia for elective surgery, ASAⅠorⅡ, both sexes, aged 20 days to 36 months, were divided into URI group （n=41） and non-URI group （n=128）, according to the preoperative symptoms of URI. The general data, the perioperative and postoperative respiratory-related complications were observed and recorded. Results （1） There was a higher incidence rate of breath holding during the operation in URI group than that of URI group. There were no significant differences in cough, sputum, blood oxygen saturation （SpO2）〈0.95, fever, glossoptosis between two groups. No fever was found in both groups. There was a higher incidence rate of sputum after operation in URI group. There were no significant differences in other complications including cough, SpO2〈0.95, fever, glossoptosis and incidence rate of breath holding between two groups. No laryngospasm and bronchospasm were found during operation and after operation in two groups. （2）The incidence of postoperative cough and fever increased, while the incidence rates of SpO2〈0.95 and glossoptosis were lower after operation compared with those during operation in non-URI group. In URI group, the incidence rate of postoperative fever was higher,and SpO2〈0.95 and breath holding was lower. There were no significant differences in other complications in URI group. Conclusion It is feasible and relatively safe to implement tracheal intubation general anesthesia for the infants with mild URI under thorough preoperative assessment and careful operative management.