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在患有高风险阻塞性睡眠呼吸暂停的儿童中,腺切除术后的术后呼吸道并发症
Yann-Fuu Kou1,2, Jonathan R Korpon1, Helene Dabbous1,2
1Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
患有高风险阻塞性睡眠呼吸暂停 (OSA) 的儿童接受腺切除术,面临呼吸道并发症. 手术前的多睡眠图 (PSG) 发现,如高呼吸暂停-呼吸暂停指数 (AHI) 和异常的氧气/二氧化碳水平,预测了这些风险.
科学领域:
- 儿科肺病学 儿科肺病学
- 睡眠医学 睡眠医学
- 麻醉学 麻醉学
背景情况:
- 阻塞性睡眠呼吸暂停 (OSA) 是儿童常见的疾病.
- 腺切除术 (AT) 是小儿OSA的主要治疗方法.
- 高风险的OSA患者可能会出现严重的术后呼吸道并发症.
研究的目的:
- 为了确定患者特征和与高风险OSA儿童AT后术后呼吸道并发症相关的多睡眠图 (PSG) 参数.
- 在这个脆弱的儿科群体中分层分类呼吸系统不良结果的风险.
主要方法:
- 进行了回顾性案例系列与图表审查.
- 包括儿童患者 (<18岁) 具有高风险的OSA (AHI>30,O2极点<80%,或峰值CO2>60 mmHg) 接受AT.
- 评估的主要结局是主要的呼吸干预,长时间住院和ICU入院.
主要成果:
- 307名儿童符合纳入标准;8.1%需要进行重大呼吸干预,9.7%需要接受ICU治疗.
- 神经肌肉疾病,较高的阻塞性呼吸暂停-呼吸暂停指数 (oAHI),较高的CO2峰值和较低的O2极点与重大干预和ICU入院有关.
- 年龄较小的儿童 (0-2岁) 和患有神经肌肉疾病的儿童患长时间住院和重症监护室住院的风险更高.
结论:
- 手术前的PSG参数,包括oAHI,氧和和二氧化碳水平,对于预测高风险儿科OSA患者手术后呼吸道并发症至关重要.
- 神经肌肉疾病和年轻年龄是严重的术后后果的重要风险因素.
- 临床医生必须考虑一套全面的PSG参数,而不仅仅是oAHI,用于风险评估和管理规划.
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