76例1岁以下小儿的围术期死亡病例分析

Analysis of 76 cases of perioperative death in children under 1 year of age

目的分析1岁以下小儿围术期死亡病例的临床特点，探讨减少围术期死亡率的措施。方法选择2011年1月～2013年12月温州医科大学附属第二医院1岁以下小儿术后死亡病例（76例）的临床资料，采用描述性流行病学方法对患者的年龄、出生体重、术前并发症、ASA（American society of anesthesiologists）分级、最终诊断，死亡时间、死亡原因进行回顾性分析。结果76例术后死亡病例中新生儿占63．2％，其出生体重为（2．18±0．85）kg。86．8％的患儿术前有合并症；麻醉ASA分级Ⅲ、Ⅳ级分别占32．9％及40．8％。73．7％患儿在术后3d内死亡，其中MODS（multiple organ dysfunction syndrome）、心力衰竭、ARDS（acute respiratory distress syndrome）是术后死亡的主要原因，占死亡例数的69．2％。结论小儿围术期死亡的危险因素是月龄、极低出生体重、术前合并疾病及高麻醉ASA分级。做好孕期保健和胎儿监测工作，加强术后抗感染、呼吸机支持治疗及对症治疗是减少1岁以内小儿围术期死亡率主要措施。

Objective To analyze the clinical characteristics of perioperative death cases and to reduce perioperative mortality in children under 1 years of age. Methods 76 cases of neonates and infants were retrospectively examined during the three years from January 2010 to December 2013 in Wenzhou medical university were retrospectively exam- ined. The descriptive epidemiological methods were used to retrospectively analyze from the following parameters： age, birth weight,preoperative complication, ASA（American Society of Anesthesiologists）classification,final diagnosis,death time and direct causes of death. Results The proportion of age between 1 day to 31 days in all 76 death cases was 63.2% whose birth weight was （2.18±0.85）kg. 86.8% of death cases suffered preoperative complication. The percent of American Society of Anesthesiologists （ASA） classification Ⅲ and IV counted for 32.9% and 40.8% respectively. 73.7% of mortalities occurred within 3 days postoperation and multiple organ dysfunction syndrome（MODS）, heart failure and acute respiratory distress syndrome（ARDS） were responsible for the death which accounted for 69.2% of death. Conclusion The risk factor of children undergoing operation under 1 year of age probably were months, low birth weight, preoperative comorbidities and high ASA classification grade. Good prenatal care and fetal monitoring, advance postoperative anti-infectlon, ventilator support therapy and symptomatic treatment might be the main measures for reducing perioperative mortality in children less than 1 year old.