上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2018, Vol. 38 ›› Issue (4): 422-.doi: 10.3969/j.issn.1674-8115.2018.04.012

• 论著·临床研究 • 上一篇    下一篇

近期合并上呼吸道感染的先天性心脏病患儿行治疗性心导管术的安全性评估

张森，蔡美华，贺盼，张瑞冬，黄悦，郑吉建   

  1. 上海交通大学医学院附属上海儿童医学中心麻醉科，上海200127
  • 出版日期:2018-04-28 发布日期:2018-05-03
  • 通讯作者: 郑吉建，电子信箱：zhengjijian626@sina.com。
  • 作者简介:张森（1992—），男，硕士生；电子信箱：zhangsen620@foxmail.com。
  • 基金资助:
    上海市浦东新区科技发展基金创新资金项目（PKJ2013-Y61，PKJ2016-Y34）

Assessment of safety about therapeutic cardiac catheterization in congenital heart disease children with recent upper respiratory tract infection

ZHANG Sen, CAI Mei-hua, HE Pan, ZHANG Rui-dong, HUANG Yue, ZHENG Ji-jian   

  1. Department of Anesthesiology, Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2018-04-28 Published:2018-05-03
  • Supported by:
    Science and Technology Innovation Fund of Pudong District of Shanghai,PKJ2013-Y61, PKJ2016-Y34

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摘要： 目的·探讨近期（2周内）合并上呼吸道感染（upper respiratory tract infection，URI）的先天性心脏病（congenital heart disease，CHD）患儿行择期治疗性心导管术的安全性，为临床麻醉管理提供指导。方法·纳入140例美国麻醉医师协会（American Society of Anesthesiologist，ASA）分级II~III级、行择期气管插管全身麻醉治疗性心导管术CHD患儿，年龄3个月~15岁。根据患儿近期URI病史，分为URI组和非URI组。观察并比较2组患儿围术期呼吸相关不良事件（perioperative respiratory adverse events，PRAEs）[即喉痉挛、支气管痉挛、呼吸暂停≥15 s、脉搏血氧饱和度（pulse blood oxygen saturation，SpO2）<95%（≥10 s）、咳嗽、舌后坠]及术后24 h内多痰、发热、兴奋烦躁、呕吐的发生率差异。结果·与非URI组相比，近期合并URI显著增加患儿PRAEs的总体发生率（发生其中任何1种）（P0.001），其中SpO2<95%（P0.014）和咳嗽（P0.000）的发生率显著增高。在URI组患儿中，年龄≤3岁的患儿PRAEs总体并发症（P0.003）、SpO2<95%（P0.018）及咳嗽（P0.027）的发生率显著高于4～15岁患儿。与非URI组相比，近期合并URI显著增加患儿术后多痰的发生率（P0.002）。结论·近期合并URI能够显著增加行择期治疗性心导管术CHD患儿围术期相关并发症的发生率；且这些并发症的发生时间较短、容易被处理，患儿无严重不良事件发生。

关键词: 上呼吸道感染, 先天性心脏病, 治疗性心导管术, 围术期呼吸相关不良事件, 术后并发症

Abstract:

Objective · To explore the safety of elective therapeutic cardiac catheterization in congenital heart disease (CHD) children with recent upper respiratory tract infection (URI) (within two weeks), so as to provide guidance for clinical anesthesia management. Methods · A total of 140 CHD children of American Society of Anesthesiologist (ASA) II~III undergoing tracheal intubation general anesthesia for elective therapeutic cardiac catheterization, aged 3 months to 15 years, were divided into URI group and non-URI group according to history of recent URI. The incidence of perioperative respiratory adverse events (PRAEs) [i.e. laryngospasm, bronchospasm, breath holding ≥15 s, pulse blood oxygen saturation (SpO2)<95%( ≥10 s),cough, and glossoptosis] and postoperative dysphoria, fever, copious sputum, and vomiting within 24 h after operation were observed and compared. Results · Compared with non-URI group, recent URI increased significantly the overall incidence of PRAEs (any complications of PRAEs) (P0.001),particularly the incidence of SpO2<95% (P0.014) and cough (P0.000). Compared with children aged 4-15 in URI group, the overall incidence of PRAEs (P0.003), SpO2<95% (P0.018), and cough (P0.027) of children younger than 3 years increased significantly. Besides, compared with non-URI group, recent URI increased significantly the incidence of postoperative copious sputum (P0.002). Conclusion · Recent URI increases significantly the incidence of perioperative complications in CHD children undergoing elective therapeutic cardiac catheterization. These complications are short and easily managed, and no serious adverse events occurred in CHD children.

Key words: upper respiratory tract infection (URI), congenital heart disease (CHD), therapeutic cardiac catheterization, perioperative respiratory adverse events (PRAEs), postoperative complications

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