中青年优秀论文评奖小儿气道异物取出术术中及术后去氧饱和的危险因素刘宇琦张旭陈莲华作者单位200031上海市徐汇区汾阳路83号复旦大学附属眼耳鼻喉科医院麻醉科通信作者陈莲华HYPERLINK"mailto:chenlianhua@citiz.net"chenlianhua@citiz.net[摘要]目的探讨小儿气道异物取出术术中及术后发生去氧饱和的危险因素。方法按前瞻性临床队列研究设计，收集2007年2月至2008年10月期间就诊于复旦大学附属眼耳鼻喉科医院的311例气道异物病例，年龄5月~12岁，ASAⅠ或Ⅱ级，记录患儿术前合并症情况、异物留存时间、异物种类、异物位置、通气方式、置镜时体动情况、手术医生、手术时间、苏醒时间及术中、术后发生去氧饱和的情况。脉搏氧饱和度下降低于90%记为一次去氧饱和事件。采用单因素比较和多因素Logistic回归方法，筛选发生术中及术后去氧饱的危险因素。结果术中发生去氧饱和事件63例，发生率20.3%。年龄分组组别低(OR=0.668，P=0.048)、术前合并肺炎(OR=3.837，P=0.003)、植物种子类异物(OR=2.654，P=0.027)、以及手术时间长于20min(OR=7.069,P＜0.001)增加术中去氧饱和的危险；与间歇正压控制通气相比，保留自主呼吸的通气方式增加术中去氧饱和危险(OR=3.152，P=0.035)，而喷射通气降低术中发生去氧饱和的危险(OR=0.161，P＜0.001)。术后去氧饱和事件37例，发生率12.2%。植物种子类异物(OR=3.678，P=0.027)及苏醒时间长(OR=1.164，P＜0.001)增加术后发生去氧饱和的危险。结论患儿年龄、术前合并肺炎、异物种类、手术时间和通气方式是患儿术中发生去氧饱和的危险因素；异物种类、苏醒时间是术后发生去氧饱和的危险因素。临床可根据以上危险因素采取相应措施以减少术中以及术后去氧饱和的发生。[关键词]去氧饱和；异物；气管；危险因素；儿童TheriskfactorsofintraoperativeandpostoperativedesaturationinchildrenundergoingforeignbodyremovalbyrigidbronchoscopeYuqiLiu,XuZhang,LianhuaChen.DepartmentofAnaesthesia,ShanghaiEyeEarNoseandThroatHospital,FudanUniversity,Shanghai200031,China.Correspondingauthor:CHENLian-hua(E-mail:chenlianhua@citiz.net)［Abstract］ObjectiveToexploretheriskfactorsofdesaturationduringandaftertheprocedureoftrachealforeignbody(FB)removalinchildren.MethodsThreehundredandelevenchildrenaged5monthto12yearsold,ASAⅠorⅡ,undergoingemergencyoperationoftrachealforeignbodyremovalfrom2007Feb.to2008Oct.inourhospital,wereenrolledinthisstudy.Complicationsbeforetheoperation,suspiciousFBpersistence,theFBtype,theFBlocation,ventilationmode,bodymovementattheinsertionofthebronchoscopy,thedepthofanesthesiaatthetimeofwithdrawingbronchoscope,theoperator,durationofoperation,durationofemergence,theoccurrenceofpostoperativelaryngospasm,intra-andpostoperativedesaturantionwererecorded.Whenthepulseoxygensaturationfellbelow90%,itwasconsideredastheoccurrenceofdesaturantion.UnivariateanalysisandmultivariateLogisticregressionanalysiswereusedtoexaminetherelationsbetweenthesefactorsandth