| 摘要: | 背景與目的：兒童呼吸道吸入異物會造成呼吸道阻塞、發炎，甚至窒息死亡，必須盡快接受硬式支氣管鏡術移除呼吸道異物，降低死亡率或併發症。但目前在臺灣關於兒童接受硬式支氣管鏡移除異物手術，發生不良事件狀況與相關因子的研究極少。本研究目的為探討呼吸道吸入異物之兒童接受硬式支氣管鏡術的圍術期間，發生不良事件之狀況與相關因子。
方法：本研究於北部某醫學中心進行，為單中心回溯性病歷研究。研究對象為民國84年9月至100年12月發生呼吸道吸入異物並接受硬式支氣管鏡手術，且有異物取出之兒童。本文利用多變項羅吉斯迴歸計算與圍術期肺炎、整體併發症、術後住加護病房及住院天數過長之相關因子的危險比（odds ratio, OR）與95%信賴區間（confidence interval, CI）。
結果：本研究收集了80位呼吸道吸入異物兒童。不良事件發生率分別為圍術期肺炎28.8%，整體併發症42.5%，術後住加護病房36.3%，住院天數過長38.3%。經多變項羅吉斯迴歸分析結果顯示圍術期肺炎的相關因子為就醫時有發燒症狀（OR = 5.36，95% CI = 1.27-22.6）、術後未立即拔管（OR = 3.55，95% CI = 1.04-12.1）。整體併發症的相關因子為術前使用抗生素（OR = 5.65，95% CI = 1.10-28.9）、手術時間（OR = 3.04，95% CI = 1.00-9.24）。性別、麻醉誘導期使用靜脈藥物（OR = 0.08，95% CI = 0.01-0.61）、維持期併用靜脈與吸入性藥物（OR = 11.62，95% CI = 1.51-89.2）為術後轉加護病房的相關因子。術前使用類固醇（OR = 6.47，95% CI = 1.06-39.4）、術後未立即拔管（OR = 45.15，95% CI = 3.14-648）為住院天數過長的相關因子。
結論：兒童呼吸道吸入異物接受硬式支氣管鏡術之不良事件相關因子包括性別、手術前有發燒症狀、手術前使用抗生素或類固醇、手術時間、術後未立即拔管、麻醉誘導期使用靜脈藥物或麻醉維持期併用靜脈與吸入性藥物。術後未立即拔管可能增加圍術期肺炎或住院天數過長危險。臨床醫護人員應意識到這些風險，並採取適當的預防措施。
Background and aim: Foreign body inhalation may cause airway obstruction, inflammation and death by asphyxiation. When it happens, children need to receive rigid bronchoscopy for foreign body aspiration as soon as possible to reduce mortality or complications. However, research into factors associated with adverse events in children receiving rigid bronchoscopy for foreign body aspiration is lacking in Taiwan. The object of this research is to examine factors associated with adverse events in children receiving rigid bronchoscopy for foreign body aspiration.
Method: A retrospective chart review was conducted in children who were admitted to a medical center in northern Taiwan for treatment of foreign body aspiration and received rigid bronchoscopy between September 1995 and December 2011. Multivariate logistic regression analysis was used to identify factors associated with adverse events, including perioperative pneumonia, overall complications, postoperative ICU stay, and increased length of hospital stay by odds ratio (OR) and 95% confidence interval (CI).
Result: Eighty patients were enrolled in this study. Among patients with adverse events, the prevalence of perioperative pneumonia, overall complications, postoperative ICU stay, and increased length of hospital stay was 28.8%, 42.5%, 36.3%, and 38.3%, respectively. Multivariate logistic regression identified the following variables as significant independent risk factors for perioperative pneumonia: fever (OR = 5.36, 95% CI = 1.27-22.6) and non-immediate extubation (OR = 3.55, 95% CI = 1.04-12.1). The risk factors for overall complications were preoperative use of antibiotics (OR = 5.65, 95% CI = 1.10-28.9) and duration of operation (OR = 3.04, 95% CI = 1.00-9.24). Gender, use of intravenous anesthesia induction (OR = 0.08, 95% CI = 0.01-0.61), combined inhalation and intravenous anesthesia maintenance (OR = 11.62, 95% CI = 1.51-89.2) were independent risk factors for postoperative ICU stay. Preoperative use of steroid (OR = 6.47, 95% CI = 1.06-39.4) and non-immediate extubation (OR = 45.15, 95% CI = 3.14-648) were factors associated with increased length of hospital stay.
Conclusion: The factors associated with adverse events in children receiving rigid bronchoscopy for foreign body aspiration included preoperative frver, preoperative antibiotics or steroid usage, duration of operation, intravenous anesthesia induction, combined inhalation and intravenous anesthesia maintenance and non-immediate extubation. Non-immediate extubation may increase risk of perioperative pneumonia or increased length of hospital stay. The clinical health professionals need to take the risk factors of the patient and prevention into consideration. |
