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上呼吸道感染後的兒童接受心導管治療術的麻醉時機：一項前瞻性觀察研究

貴州醫科大學麻醉與心臟電生理課題組  

翻譯：李奕 編輯：陳銳 審校：曹瑩

背景

  我們目的在分析小兒上呼吸道感染(URI)後接受心導管治療術的麻醉時機及圍手術期呼吸道不良事件(PRAE)的危險因素。    HOLIDAY  

方法

  我們前瞻性地納入了擇期行心導管治療插入術的兒童。父母或法定監護人填寫一份關於人口統計、煙草接觸和URI症狀的調查問卷。記錄PRAEs (喉痙攣、支氣管痙攣、咳嗽、氣道分泌物、氣道阻塞、氧飽和度下降)以及麻醉管理的細節。 HOLIDAY  

主要結果

在 332 名兒童中，201 名在過去 8 周內有 URI 病史。URI點2周患兒PRAEs發生率最高，高於無URI患兒（66.3%vs46.6%，P=0.007）。URI3~8周患兒PRAEs總發生率明顯低於近2周內患有URI的患兒（49.0%vs 66.3%，P=0.007），與對照組相似（49.0%vs46.6%）。多變數回顧分析顯示 PRAEs 與先天性心臟病 (CHD) 類型 (P<0.001)、麻醉時程 (P=0.007) 和年齡 (P=0.021) 之間存在關聯。延遲時間表（URI 後兩周）將 PRAEs 的風險降至與在沒有 URI 的兒童中觀察到的水準相當（OR，1.11；95% CI：0.64-1.91；P=0.707）。

結論 如果不需要緊急手術，  PRAEs 高風險的兒科患者  將介入手術推遲到URI後至少兩周更有益。  

原始文獻來源   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點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 點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.