唇腭裂患儿术前上呼吸道感染相关症状对术后生命体征影响的初步分析

Preliminary analysis on correlations between the symptoms related to upper respiratory infection and vital signs after operation of infants with cleft lip and/or palate

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。

Objective This study aims to test the correlations between upper respiratory infection（URI） and vital signs after cleft lip and/or palate（CL/P） surgery to find out some preoperative manifestations that may predict surgical risk. Methods The investigators implemented retrospective studies. A total of 1 000 medical records of infants who had CL/ P surgery were randomly collected. The predictor variable was several preoperative symptoms related to URI, and the outcome variable was vital signs after operation. Then, two kinds of variables were exchanged. Descriptive and univariate analyses were computed to find the links. Results About 93.3% of the infants suffered abnormal vital signs within 24 h after operation, but most complications were mild. Two groups, which were divided by whether the highest preoperative temperature was normal or not, had statistically different proportions of abnormal postoperative temperature and systolic blood pressure（SBP） （P〈0.05）. Univariate analysis results： an excessive white blood cell count caused statistically different postoperative SBP and respiratory rate, as compared with the normal white blood cell count（P〈0.05）. A fever caused different postoperative temperature, SBP, and respiratory rate（P〈0.05）. A diagnosis of URI caused different postoperative SBP and oxyhemoglobin saturation（P〈0.05）. Conclusion Tolerating CL/P surgery under general anesthesia is relatively safe for children with only slight URI symptoms, whereas a careful monitoring is indispensable. Moreover, temperature before surgery is a sensitive indicator, and white blood cell count and diagnosis of URI are also ponderable.