抄録
【目的】小児の予定小手術に際し実施すべき術前検査に関する一定の基準は示されておらず, 検査の内容は施設ごとに相違がある.今回, 小児の予定小手術における術前ルーチン検査の有用性および必要性について検討を行った.【対象と方法】全身麻酔下の予定小手術を目的に入院した1,005例の1,069回の入院を対象に, ルーチンに実施された術前検査の異常の有無と, 手術の中止(延期)ならびに周術期合併症に関し後方視的に検討した.【結果】入院後の手術中止は33回(33例)(3.1%)で, その理由は感冒症状が29例, 乳児肝炎, 鉄欠乏性貧血が各1例, 社会的理由が2例であった.乳児肝炎と鉄欠乏性貧血の症例は術前検査でそれぞれトランスアミナーゼの高値と貧血を指摘され手術が中止された.CRPの高値10例も手術が中止になったが, 全例感冒症状をともなっており, CRPのみを理由に中止された症例はなかった.尿検査, 胸部X線および心電図の異常により手術が中止された症例は認めなかった.周術期の合併症として高血圧を1例に認めたが, その他, 術前検査やその異常に関連する合併症は認めなかった.【結論】小児予定小手術の術前ルーチン検査の有用性を積極的に支持する根拠は乏しく, 問診, 理学所見とその結果, 必要な検査で術前評価を行っても安全に麻酔, 手術を実施し得る可能性が示唆された.特に尿検査, 心電図は手術の可否の判断を目的としたルーチン検査としては不要で, 血液検査も血算, 肝機能, 感染症のチェックなどに限定し得ると考えられた.
Purpose : There are no guidelines for routine preoperative examinations in children undergoing elective minor surgery and the examinations performed are different depending on hospitals. To know whether routine examinations prior to elective minor surgery are necessary, we investigated the usefulness of the examinations. Materials and Methods : The results of routine laboratory blood tests, urinalysis, chest X-ray and electrocardiogram (ECG) performed preoperatively in 1,069 admissions of 1,005 patients were analyzed. The reasons for cancellation of surgery and perioperative complications were also examined. Results : A total of 33 surgeries were cancelled (3.1% of 1,069 admissions) and the reasons were upper respiratory tract infections in 29 patients, social reasons in 2 patients, and hepatitis and iron deficiency anemia in one patient each. The diagnoses of the last two illnesses were made by the results of laboratory blood tests. Surgery was cancelled in 10 patients with elevated CRP, all of whom had symptoms of upper respiratory tract infections. No surgery was cancelled due to the findings of urinalysis, chest X-ray or ECG. Although one patient had hypertension during and after surgery, there were no complications related to the findings of preoperative examinations. Conclusions : Evidence showing the benefits of routine preoperative examinations was scant. A thorough clinical assessment with necessary examinations may be substituted for routine examinations without compromising the safety of anesthesia and surgery in children undergoing elective minor surgery. Urinalysis and ECG are unnecessary and laboratory blood tests should be limited to blood count, liver enzymes and infection survey.
