Respiratory compromise after adenotonsillectomy in children with obstructive sleep apnea.
Respiratory compromise after adenotonsillectomy in children with obstructive sleep apnea.
复制标题
阻塞性睡眠呼吸暂停儿童腺样体扁桃体切除术后的呼吸损害。
DOI：
10.1001/archotol.1992.01880090056017
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发表时间：
1992
期刊：
影响因子：
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通讯作者：
G. Loughlin
中科院分区：
文献类型：
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作者：
S. McColley;M. April;J. Carroll;R. Naclerio;G. Loughlin
对1987~1990年间行扁桃体切除术的阻塞性睡眠呼吸暂停患儿进行了回顾性研究，以确定术后呼吸损害的发生率，并确定其发生的危险因素。69名18岁以下的患者有多导睡眠图记录的阻塞性睡眠呼吸暂停，并在儿科重症监护病房进行了术后观察。其中，16例(23%)有严重的呼吸损害，定义为间歇性或持续性血氧饱和度低于70%，和/或高碳酸血症，需要干预。与没有呼吸障碍的患者相比，这些患者更年轻(3.4+/-4vs6.1+/-4岁)，多导睡眠图每小时睡眠障碍事件更多(49+/-41vs19+/-30)。他们的年龄(优势比[OR]，5.1；95%可信区间[CI]，1.4~18.7)、心电图和/或超声心动图异常(OR，4.5；95%CI，1.3~15.1)、头面部畸形(OR，6.2；95%CI，1.5~26)的风险更大。多因素Logistic回归分析显示，年龄在3岁以下和梗阻事件指数大于10是最显著的危险因素。阻塞性睡眠呼吸暂停儿童存在扁桃体切除术后呼吸损害的风险；年龄较小和严重的睡眠相关上呼吸道阻塞显著增加了这种风险。我们建议对因阻塞性睡眠呼吸暂停而行扁桃体切除术的儿童进行院内术后监测。
A retrospective study of pediatric patients with obstructive sleep apnea who underwent adenotonsillectomy between 1987 and 1990 was undertaken to determine the frequency of postoperative respiratory compromise and to determine if risk factors for its development could be identified. Sixty-nine patients less than 18 years old had polysomnographically documented obstructive sleep apnea and were observed postoperatively in the pediatric intensive care unit. Of these, 16 (23%) had severe respiratory compromise, defined as intermittent or continuous oxygen saturation of 70% or less, and/or hypercapnia, requiring intervention. Compared with patients without respiratory compromise, these patients were younger (3.4 +/- 4 vs 6.1 +/- 4 years) and had more obstructive events per hour of sleep on the polysomnogram (49 +/- 41 vs 19 +/- 30). They were more likely to weight less than the fifth percentile for age (odds ratio [OR], 5.1; 95% confidence interval [CI], 1.4 to 18.7), to have an abnormal electrocardiogram and/or echocardiogram (OR, 4.5; 95% CI, 1.3 to 15.1), and to have a craniofacial abnormality (OR, 6.2; 95% CI, 1.5 to 26). Multiple logistic regression analysis revealed the most significant risk factors were age below 3 years and an obstructive event index greater than 10. Children with obstructive sleep apnea are at risk for respiratory compromise following adenotonsillectomy; young age and severe sleep-related upper airway obstruction significantly increase this risk. We recommend in-hospital postoperative monitoring for children undergoing adenotonsillectomy for obstructive sleep apnea.