上呼吸道感染后的儿童接受心导管治疗术的麻醉时机:一项前瞻性观察研究

2022
01/14

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如果不需要紧急手术,  PRAEs 高风险的儿科患者  将介入手术推迟到URI后至少两周更有益。  

本文由“罂粟花”授权转载


上呼吸道感染后的儿童接受心导管治疗术的麻醉时机:一项前瞻性观察研究

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贵州医科大学麻醉与心脏电生理课题组  

翻译:李奕 编辑:陈锐 审校:曹莹

背景

  我们目的在分析小儿上呼吸道感染(URI)后接受心导管治疗术的麻醉时机及围手术期呼吸道不良事件(PRAE)的危险因素。    HOLIDAY  

方法

  我们前瞻性地纳入了择期行心导管治疗插入术的儿童。父母或法定监护人填写一份关于人口统计、烟草接触和URI症状的调查问卷。记录PRAEs (喉痉挛、支气管痉挛、咳嗽、气道分泌物、气道阻塞、氧饱和度下降)以及麻醉管理的细节。 HOLIDAY  

主要结果

在 332 名儿童中,201 名在过去 8 周内有 URI 病史。URI≤2周患儿PRAEs发生率最高,高于无URI患儿(66.3%vs46.6%,P=0.007)。URI3~8周患儿PRAEs总发生率明显低于近2周内患有URI的患儿(49.0%vs 66.3%,P=0.007),与对照组相似(49.0%vs46.6%)。多变量回顾分析显示 PRAEs 与先天性心脏病 (CHD) 类型 (P<0.001)、麻醉时程 (P=0.007) 和年龄 (P=0.021) 之间存在关联。延迟时间表(URI 后两周)将 PRAEs 的风险降至与在没有 URI 的儿童中观察到的水平相当(OR,1.11;95% CI:0.64-1.91;P=0.707)。

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结论 如果不需要紧急手术,  PRAEs 高风险的儿科患者  将介入手术推迟到URI后至少两周更有益。  

原始文献来源   Zhang K, Wang S, Li M, Wu C, Sun L, Zhang S, et al. Anesthesia timing for children undergoing therapeutic cardiac catheterization after upper respiratory infection: a prospective observational study.     [J].  Minerva Anestesiol 2020;86:835-43.


Anesthesia timing for children undergoing therapeutic cardiac catheterization after upper respiratory infection: a prospective observational study

Abstract

Background: We aimed to analyze anesthesia timing and perioperative respiratory adverse event (PRAE) risk factors in children undergoing therapeutic cardiac catheterization after upper respiratory tract infection (URI). 

Method: We prospectively included children for elective therapeutic cardiac catheterization. Parents or legal guardians were asked to complete a questionnaire on the child's demographics, tobacco exposure, and URI symptoms. PRAEs (laryngospasm, bronchospasm, coughing, airway secretion, airway obstruction, and oxygen desaturation) as well as details of anesthesia management were recorded.

Results: Of 332 children, 201 had a history of URI in the preceding eight weeks. The occurrence rate of PRAEs in children with URI≤two weeks reached the highest proportion, which was higher than that in children without URI (66.3% vs. 46.6%, P=0.007). The overall incidence of PRAEs in children with URI in 3-8 weeks was significantly lower than that in children with URI in the recent ≤two weeks (49.0% vs. 66.3%, P=0.007), and similar to that in the control group (49.0% vs. 46.6%). Multivariate analysis showed association between PRAEs and type of congenital heart disease (CHD) (P<0.001), anesthesia timing (P=0.007), and age (P=0.021). Delayed schedule (two weeks after URI) minimized the risk of PRAEs to the level comparable to that observed in children without URI (OR, 1.11; 95% CI: 0.64-1.91; P=0.707).

Conclusion: If treatment is not urgent, a pediatric patient at a high risk of PRAEs will be benefit from the postponement of an interventional operation by at least two weeks after URI.

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关键词:
儿童,治疗,麻醉,导管,患儿

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