儿童支气管镜气道异物取出术围术期呼吸系统严重并发症的危险因素分析

Analysis of risk factors of perioperative severe respiratory complications in children undergoing bronchoscopic removal of airway foreign body

目的探讨支气管镜气道异物取出术患儿围术期呼吸系统严重并发症的危险因素。方法选择2019年6月至2021年6月徐州市儿童医院收治的行支气管镜气道异物取出术的患儿291例,对患儿临床资料进行回顾性分析,将术中及术后24 h内未发生呼吸系统严重并发症的患儿作为无并发症组,将术中及术后24 h内发生呼吸系统严重并发症的患儿作为并发症组。对比两组一般资料、手术时间、异物存留时间、异物位置、异物类型等资料,再对单因素分析中差异有统计学意义的因素进行logistic回归分析,确定患儿发生围术期呼吸系统严重并发症的危险因素。计量资料采用独立样本t检验,计数资料采用χ^(2)检验。结果291例患儿共37例发生并发症,发生率为12.71%(37/291)。并发症组男19例、女18例,年龄(3.12±0.51)岁;无并发症组男163例、女91例,年龄(3.19±0.59)岁。并发症组患儿手术时间、异物存留时间、术前呼吸道感染及麻醉效果不佳比例分别为(20.12±4.05)min、(7.09±0.48)d、51.35%(19/37)、70.27%(26/37),均高于无并发症组[(12.18±1.11)min、(3.61±0.55)d、12.99%(33/254)、7.48%(19/254)],差异均有统计学意义(均P<0.05)。多因素logistic回归分析发现手术时间、异物存留时间、术前呼吸道感染、麻醉效果不佳是患儿围术期呼吸系统严重并发症发生的危险因素(均P<0.05)。结论支气管镜气道异物取出术患儿围术期呼吸系统严重并发症的危险因素主要为手术时间、异物存留时间、术前呼吸道感染、麻醉效果不佳,临床应警惕并及时采取预防措施。

Objective To explore the risk factors of perioperative severe respiratory complications in children undergoing bronchoscopic removal of airway foreign body.Methods A total of 291 children who underwent bronchoscopic removal of airway foreign body in Xuzhou Children's Hospital from June 2019 to June 2021 were selected.The children's clinical data were retrospectively analyzed.The children who did not have serious respiratory complications during operation and within 24 hours after operation were regarded as a complication free group,and the children who had serious respiratory complications during operation and within 24 hours after operation were regarded as a complication group.The general data,operation time,foreign body retention time,foreign body location,foreign body type,and other data were compared between the two groups,and logistic regression analysis was performed for the factors with statistically significant differences in the univariate analysis to determine the risk factors for perioperative severe respiratory complications.Independent sample t test was used for the measurement data,andχ2 test was used for the count data.Results The complications occurred in 37 cases of 291 children,with an incidence of 12.71%(37/291).The complication group included 19 males and 18 females,aged(3.12±0.51)years;the complication free group included 163 males and 91 females,aged(3.19±0.59)years.In the complication group,the operation time,foreign body retention time,and rates of preoperative respiratory tract infection and poor anesthetic effect were(20.12±4.05)min,(7.09±0.48)d,51.35%(19/37),and 70.27%(26/37),respectively,which were significantly higher than those in the complication free group[(12.18±1.11)min,(3.61±0.55)d,12.99%(33/254),and 7.48%(19/254)],with statistically significant differences(all P<0.05).Multivariate logistic regression analysis showed that operation time,foreign body retention time,preoperative respiratory tract infection,and poor anesthetic effect were the risk factors of perioperative serious respiratory complications(all P<0.05).Conclusions The risk factors of perioperative serious respiratory complications in children undergoing bronchoscopic removal of airway foreign body mainly include operation time,foreign body retention time,preoperative respiratory tract infection,and poor anesthetic effect.Clinical vigilance and preventive measures should be taken in time.