腺扁桃体切除术后入院儿童的持续血氧监测：一项观察性研究

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中文摘要

引言： 接受腺扁桃体切除术（AT）的儿童常因术后呼吸事件的担忧而留院过夜。目前的入院指南主要基于回顾性数据。持续夜间血氧监测可能更好地界定有临床意义的术后血氧饱和度下降的发生率和严重程度。我们旨在确定因AT入院的无综合征儿童中，发生显著夜间血氧饱和度下降（SpO2 <85%持续>30秒）或需要补充氧气的发生率。
方法： 这项前瞻性观察性研究在德克萨斯儿童医院进行，该医院是一家三级独立儿科医院。对2024年7月26日至2025年5月27日期间连续入院的AT术后患者进行了资格评估。夜间血氧监测数据少于4小时的患者被排除。最终分析包括147名无综合征儿童，包括3岁以下儿童、经术前多导睡眠图确认患有严重阻塞性睡眠呼吸暂停的儿童，以及因术后观察而入院的病态肥胖儿童（BMI >99百分位）。患有显著合并症、遗传综合征或颅面异常的患者被纳入，但作为补充队列单独分析。主要结局是严重血氧饱和度下降事件（SpO2 <85%持续>30秒）的发生率和频率，以及夜间补充氧气的需求。
结果： 在评估的508名患者中，315名被纳入，147名无综合征儿童符合主要分析的纳入标准。在这些患者中，57.8%为男性，中位年龄7.0岁，中位体重40.6公斤，中位BMI 25.0 kg/m2；70.7%被归类为肥胖（BMI >95百分位）。13名患者（8.8%）经历了至少一次严重夜间血氧饱和度下降事件（SpO2 <85%持续>30秒），而11名患者（7.5%）因持续血氧饱和度下降需要夜间补充氧气。与没有严重事件的患者相比，至少有一次严重血氧饱和度下降事件的患者经历了更多的中度血氧饱和度下降事件（中位数12.0 vs. 2.5次；p = 0.045）和更长的中度血氧饱和度下降持续时间（每次事件72.0 vs. 32.4秒；p = 0.01）。在麻醉后监护室需要补充氧气与夜间需要补充氧气强烈相关（比值比12.1；95% CI，4.3-34.27；p < 0.001）。
结论： 在这项对AT术后入院的无综合征儿童的前瞻性观察性研究中，一小部分无综合征儿童在AT术后夜间经历了至少1次严重血氧饱和度下降事件（SpO2 <85%持续>30秒）。需要进一步研究以阐明预测AT术后严重血氧饱和度下降的因素。PACU氧气与夜间补充氧气的需求相关。这项研究表明，有术前URI症状或需要在PACU补充氧气的患者应考虑进行夜间观察。

英文摘要

INTRODUCTION: Children undergoing adenotonsillectomy (AT) are frequently admitted overnight because of concerns regarding postoperative respiratory events. The current admission guidelines are largely based on retrospective data. Continuous overnight oximetry may better define the incidence and severity of clinically meaningful postoperative desaturation. We sought to determine the incidence of significant overnight oxygen desaturation (SpO2 <85% for >30 s) or supplemental oxygen requirement in non-syndromic children admitted for AT.
METHODS: This prospective observational study was conducted at the Texas Children's Hospital, a tertiary freestanding pediatric hospital. Consecutive patients admitted following AT between July 26, 2024, and May 27, 2025, were assessed for eligibility. Patients with fewer than 4 h of overnight oximetry data were excluded. The final analysis included 147 non-syndromic children, including those younger than 3 years, those with severe obstructive sleep apnea confirmed by preoperative polysomnography, and those with morbid obesity (BMI >99th percentile) who were admitted for postoperative observation. Patients with significant comorbidities, genetic syndromes, or craniofacial abnormalities were enrolled but were analyzed separately as a supplementary cohort. The primary outcomes were the incidence and frequency of severe oxygen desaturation events (SpO2 <85% for >30 s) and the requirement for overnight supplemental oxygen.
RESULTS: Of the 508 patients assessed for eligibility, 315 were enrolled, and 147 non-syndromic children met the inclusion criteria for the primary analysis. Among these patients, 57.8% were male, with a median age of 7.0 years, median weight of 40.6 kg, and median BMI of 25.0 kg/m2; 70.7% were classified as obese (BMI >95th percentile). Thirteen patients (8.8%) experienced at least one severe overnight desaturation event (SpO2 <85% for >30 s), whereas 11 patients (7.5%) required supplemental overnight oxygen because of sustained desaturation. Patients with at least one severe desaturation event experienced a greater number of moderate desaturation events (median 12.0 vs. 2.5 events; p = 0.045) and longer moderate desaturation duration (72.0 vs. 32.4 s per event; p = 0.01) than those without severe events. The need for supplemental oxygen in the postanesthesia care unit was strongly associated with the need for supplemental oxygen overnight (odds ratio 12.1; 95% CI, 4.3-34.27; p < 0.001).
CONCLUSION: In this prospective observational study of non-syndromic children admitted following AT surgery, a small subset of non-syndromic children experienced severe ≥1 severe desaturation events (SpO2 <85% for >30 s) overnight after AT. Further investigation is warranted to elucidate the factors predicting severe desaturation following AT surgery. PACU oxygen was associated with the need for overnight supplemental oxygen. This study suggests that patients with preoperative URI symptoms or those requiring supplemental oxygen in the PACU should be considered for overnight observation.