非心脏胸科手术患者异常苏醒的危险因素  

Risk factors for inadequate emergence after non-cardiac thoracic surgery

作　　者：李成文[1] 史继红[2] 王昆[1] 孙波[3] 高国栋[3] 

机构地区：[1]济宁市第一人民医院麻醉科,272011 [2]济宁市第一人民医院心理门诊,272011 [3]济宁市第一人民医院胸外科,272011

出　　处：《临床麻醉学杂志》2016年第1期33-37,共5页Journal of Clinical Anesthesiology

基　　金：山东省自然科学基金(ZR2010HQ007)

摘　　要：目的探讨非心脏胸科手术患者异常苏醒（苏醒期谵妄和苏醒延迟）的危险因素。方法选择全凭静脉麻醉下择期行非心脏胸科手术患者160例,男119例,女41例,年龄18~80岁,ASAⅠ~Ⅲ级,麻醉维持BIS值在30-60。在气管导管拔除后、达PACU后10min和出PACU时采用Riker镇静躁动量表（SAS）评估苏醒程度,SAS评分≥5分为苏醒期谵妄,SAS评分≤2分且持续时间达正常苏醒者清醒时间平均值＋3倍标准差者为苏醒延迟。结果 66例（41.3%）患者发生苏醒期谵妄;17例（10.6%）患者发生苏醒延迟。BMI〉25.0kg/m2（OR=0.825,95%CI 0.747-0.911,P〈0.001）增加苏醒期谵妄的危险;老年（OR=0.766,95%CI 0.642~0.914,P=0.003）、BMI〈18.5kg/m2（OR=1.769,95%CI 1.224~2.557,P=0.002）和术中低血压（OR=0.123,95%CI0.018~0.833,P=0.032）增加苏醒延迟的危险。结论高BMI是苏醒期谵妄的危险因素;老年、低BMI和术中低血压是苏醒延迟的危险因素。Objective To explore the risk factors for inadequate emergence （emergence delirium and delayed emergence） after non-cardiac thoracic surgery.Methods One hundred and sixty adult patients （male 119 and female 41, aged 18-80 years, ASA grades Ⅰ-Ⅲ） undergoing elective non-cardiac thoracic surgery received total intravenous anesthesia at a BIS target of 30-60. Emergence was assessed immediately after extubation, 10 min after admittance to postanesthetic care unit （PACU） and immediately before discharge from PACU using Riker sedation-agitation scale （SAS）. Emergence delirium was defined as a SAS score≥5, and delayed emergence was defined as a SAS score≤2 with a duration no less than mean emergence time plus 3 standard deviations derived from patients with normal emergence. Results The emergence were 41.3% and 10. 6%, respectively. incidences of emergence delirium and delayed BMI more than 25.0 kg/m2 （OR=0. 825,95%CI 0. 747-0. 911,P〈0. 001） increased the risk of emergence delirium. Old age （OR=0. 766, 95%CI 0. 642-0. 914,P =0. 003）, BMI less than 18. 5 kg/m2 （OR=I. 769,95%CI 1.224-2. 557, P=0. 002） and intraoperative hypotension （OR=0. 123,95MCI 0. 018-0. 833, P=0. 032） increased the risk of delayed emergence.Conclusion High BMI is a risk factor for emergence delirium. Old age, low BMI and intraoperative hypotension are risk factors for delayed emergence.

关 键 词：麻醉恢复 胸科手术 麻醉深度 

分 类 号：R614[医药卫生—麻醉学]