择期全麻患儿合并中轻度URTI对不同时期呼吸系统并发症及气道管理方式的影响

Effects of mild URTI in children with elective general anesthesia on airway management and respiratory complications at different stages

目的 探讨择期全麻患儿合并中轻度上呼吸道感染(Upper respiratory tract infections, URTI)对不同时期呼吸系统并发症及气道管理方式的影响。方法 初次筛取永煤集团总医院2018年9月至2020年9月行择期外科手术全身麻醉患儿587例,将520例按期实施手术患儿纳入研究,依据术前体征、URTI症状监测情况分作URTI组(n=80例,鼻咽部中轻度URTI患儿)及非URTI组(n=440例,无体征及URTI症状表现患儿),其中,URTI组依循感染严重程度又分为中度URTI组(n=25例)、轻度URTI组(n=55例)。比较两组感染严重程度下气道管理方式差异,分析两组不同时期呼吸系统并发症影响及探询中、轻度URTI并发症发生率。结果 实施气管插管全麻492例,URTI组76例(中度25例、轻度51例),占比15.45%;实施喉罩及声门上通气全麻28例,URTI组4例(轻度4例),比14.29%,URTI组气道管理中实施气管插管、喉罩及声门上通气全麻处理构成比差异无统计学意义(P>0.05);URTI组手术室内、麻醉恢复室内、术后6h、术后24 h呼吸系统并发症发生率为20.00%、40.00%、51.25%、25.00%,相较于非URTI组的7.05%、22.05%、24.77%、10.23%均显著增高,差异有统计学意义(P<0.05),且中度URTI组手术室内、麻醉恢复室内、术后6 h、术后24 h呼吸系统并发症发生率为40.00%、72.00%、84.00%、48.00%,较之轻度URTI组的10.91%、25.45%、36.36%、14.55%均显著增高,差异有统计学意义(P<0.05)。结论 合并中轻度URTI患儿,多实施气管插管全麻处理,但其呼吸系统并发症发生率较高,故应根据患儿自身情形合理选取低侵害性的气道装置。此外,麻醉恢复室内及术后6h为呼吸系统并发症高危时期,应侧重于麻醉恢复室内进行麻醉复苏,有助于提高围术期麻醉安全性。

Objective To investigate the effect of mild URTI in children with elective general anesthesia on airway management and respiratory complications at different stages.Method First sieve in our hospital between September 2018 and September 2020,587 cases of children undergoing elective general anesthesia surgery, 520 cases timely surgery were included in the research, on the basis of preoperative symptoms, monitoring URTI symptoms into URTI group(n=80 cases children with mild URTI) in nasopharyngeal and non URTI group(n=440 cases, no children with signs and URTI symptoms),among them, the URTI following infection severity is divided into moderate URTI group(n=25),mild URTI group(n=55 cases).The differences in airway management under the severity of infection between the two groups were compared, and the influence of respiratory complications in different periods and the incidence of moderate and mild URTI complications were analyzed.Results There were 492 cases of general anesthesia with endotracheal intubation, 76 cases(25 cases moderate, 51 cases mild) in URTI group, accounting for 15.45%.There were 28 cases of laryngeal mask airway and supravglottic general anesthesia, and 4 cases(mild 4 cases) in URTI group, accounting for 14.29%.There was no statistically significant difference in the composition ratio of endotracheal intubation, laryngeal mask airway and supravglottic general anesthesia in URTI group during airway management(P>0.05).The incidence of respiratory complications in the URTI group was 20.00%,40.00%,51.25% and 25.00% in the operating room, anesthesia recovery room, 6 h and 24 h after surgery, which were significantly higher than those in the non-URTI group 7.05%,22.05%,24.77% and 10.23%,with statistically significant differences(P<0.05).In addition, the incidence of respiratory complications in the surgery room, anesthesia recovery room, 6 h and 24 h after surgery in the moderate URTI group was 40.00%,72.00%,84.00%,48.00%,significantly higher than that in the mild URTI group 10.91%,25.45%,36.36%,14.55%,with statistically significant differences(P<0.05).Conclusion Children with mild URTI were mostly treated with endotracheal intubation under general anesthesia, but the incidence of respiratory complications was relatively high.Therefore, the airway devices with low invasive nature should be reasonably selected according to the children’s own conditions.In addition, anesthesia recovery room and 6 h after the operation are high-risk periods of respiratory complications, so anesthesia recovery in the anesthesia recovery room should be focused on, which is helpful to improve the safety of perioperative anesthesia.