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【科普】与吸烟者共同生活的儿童在手术其间更
Children are especially vulnerable to the effects of secondhand smoking, both because they are small and still growing and because they're often a "captive audience" for tobacco smoke. Now, researchers identify another problem: a greater risk for respiratory complications during outpatient surgical procedures.
Dwight Jones, MD, of Children's Hospital Boston and Neil Bhattacharyya, MD, from Brigham and Women's Hospital followed 405 children, 168 of whom came from households with smokers. The children were having day surgical procedures at Children's, ranging from drainage of middle-ear fluid to circumcision to hernia repair. All had general anesthesia and received oxygen through a face mask.
Children who lived with smokers had a higher incidence of respiratory problems during surgery than those from nonsmoking households: excessive mucus secretion (38 percent vs. 8 percent), breath-holding (15 percent vs. 6 percent), constriction of the larynx or bronchial tubes that potentially could impair breathing (29 percent vs. 5 percent), and actual airway obstruction (29 percent vs. 11 percent). Respiratory problems were similarly increased in the recovery room, but to a lesser extent.
"It was in the wakeup period in the operating room that they did the worst," says Jones, a pediatric otolaryngologist at Children's. "We had a harder time waking up children coming out from anesthesia because of choking, gagging and secretions."
Some children who lived with smokers required additional airway support, including bronchodilators and supplementary oxygen, and had to stay in the hospital overnight. With the exception of actual airway obstruction, the more cigarettes smoked per day in the home, the more severe the children's respiratory complications during surgery.
The study results, published in the July 1 issue of the journal Otolaryngology-Head and Neck Surgery, suggest that children exposed to secondhand smoke may require more attention to their airways during surgery, particularly if they are receiving ventilation by face mask, the usual method for minor surgical procedures and in patients with heart or lung disease. Instead of face-mask ventilation, anesthesiologists may now want to consider placing an endotracheal tube to protect children against airway constriction and prevent aspiration of mucus, Jones says.
"Anesthesiologists need to have a higher level of suspicion when taking a patient history, and should find out whether the parents smoke or if there's any tobacco smoked in the home," Jones says. "Based on our findings, they might be more likely to tell parents that their child might have more problems during wakeup from anesthesia and might need to be admitted overnight, rather than go home the same day."
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Founded in 1869 as a 20-bed hospital for children, Children's Hospital Boston today is the nation's leading pediatric medical center, the largest provider of health care to Massachusetts children, and the primary pediatric teaching hospital of Harvard Medical School. In addition to 347 pediatric and adolescent inpatient beds and comprehensive outpatient programs, Children's houses the world's largest research enterprise based at a pediatric medical center, where its discoveries benefit both children and adults. More than 500 scientists, including eight members of the National Academy of Sciences, nine members of the Institute of Medicine and 11 members of the Howard Hughes Medical Institute comprise Children's research community. For more information about the hospital visit: http://www.childrenshospital.org. 我来认领，下午交作业 与吸烟者共同生活的儿童在手术其间更容易发生呼吸系统并发症
儿童尤其容易受到二手烟影响的危害，既因为他们还小，正在发育，也因为他们对吸烟好奇而不走开。现在，研究发现另一个问题：（吸烟）使外科门诊病人有更高的患呼吸系统并发症的风险。
来自波士顿儿童医院的医学博士德怀特琼斯，和来自布里汉妇女医院的医学博士内尔跟踪调查了405名儿童，其中168名家庭中有吸烟者。这些儿童正在儿童医院进行手术，手术范围从中耳液体排出到包皮环切术到疝修补术。所有儿童都进行了全麻及通过面罩吸氧。
与吸烟者一起居住的儿童比家庭中无吸烟者的儿童在手术中发生呼吸系统问题的几率更高：过多的粘液分泌物（38％比8％），呼吸抑制（15％比6％），潜在地使呼吸减弱的喉或支气管痉挛（29％比5％），和气道堵塞（29％比11％）。在恢复室，呼吸问题也类似地上升了，只不过程度小些。
“在手术室里儿童复苏期间情况最糟，”来自儿童医院小儿耳鼻喉科医师琼斯说: “由于窒息、气道堵塞及分泌物多，使我们要让儿童从麻醉中复苏更加困难。”
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作者:admin@医学,生命科学 2011-04-02 05:11
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