新生儿坏死性小肠结肠炎全麻手术后苏醒延迟的相关因素分析  

Risk factors of delayed recovery after general anesthesia in infants with neonatal necrotizing enterocolitis

作　　者：周思海 顾茜 刘晓莉 张亮 阿里木江·阿不都热依木 Zhou Sihai;Gu Qian;Liu Xiaoli;Zhang Liang;Alimujiang Abudureyimu(Department of Anesthesiology,First People s Hospital(Children's Hospital),Urumqi Xinjiang 830002,China)

机构地区：[1]新疆乌鲁木齐市第一人民医院(儿童医院)麻醉科,新疆维吾尔自治区乌鲁木齐市830002

出　　处：《临床小儿外科杂志》2021年第10期968-973,共6页Journal of Clinical Pediatric Surgery

基　　金：新疆维吾尔自治区自然科学基金(编号:2019D01A12)。

摘　　要：目的探讨新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)全麻手术后苏醒延迟的相关因素。方法回顾性2012年1月至2019年12月乌鲁木齐市第一人民医院采取手术治疗的213例NEC患者临床资料,记录其苏醒情况。将麻醉结束后意识恢复时间>90 min定义为苏醒延迟;按苏醒时间将研究对象分为延迟苏醒组(n=26)和正常苏醒组(n=187)。采用单因素分析及多因素Logistic回归方法筛选NEC全麻手术后苏醒延迟的相关因素。结果213例中,发生苏醒延迟26例(12.2%)。单因素分析显示:矫正胎龄、ASA分级、术前血清肌酐、术中使用血管活性药物、术中低鼻咽温度、肠坏死并穿孔、麻醉结束时血乳酸水平是导致术后苏醒延迟的相关因素(P<0.05);Logistic回归分析结果显示:术前血肌酐水平(OR=1.081,95%CI:1.042~1.122)、术中低鼻咽温度(OR=2.268,95%CI:1.291~4.016)和麻醉结束时血乳酸水平(OR=2.643,95%CI:1.361~5.131)是NEC患者手术后苏醒延迟的独立相关因素(P<0.05)。联合术前血肌酐和麻醉结束时血乳酸水平两个指标绘制ROC曲线,曲线下面积为0.81(P<0.001),提示术前血肌酐和麻醉结束时血乳酸水平对NEC患者术后苏醒延迟有较好的预测意义。结论NEC患者全麻手术后发生苏醒延迟与诸多因素相关,保护重要脏器功能、加强保温、维持酸碱平衡是预防苏醒延迟的重要措施。Objective To explore the risk factors of delayed recovery after general anesthesia in infants with neonatal necrotizing enterocolitis(NEC).Methods Clinical data were retrospectively analyzed for 213 NEC infants operated under general anesthesia from January 2012 to December 2019.They were divided into two groups of delayed(n=26)and normal(n=187)according to the definition that whether or not consciousness recovered in 90 min after an end of general anesthesia.Univariate and multivariate Logistic regressions were utilized for examining the risk factors of delayed recovery after general anesthesia in NEC infants.Results Delayed recovery occurred in 26/213 cases with an incidence of 12.2%.Univariate analysis showed that corrected gestational age,ASA classification,preoperative serum creatinine,intraoperative use of vasoactive agents,low nasopharyngeal temperature during operation,intestinal necrosis with perforation and lactic acid level at an end of anesthesia were the risk factors for the occurrence of delayed recovery(P<0.05).Logistic regression analysis indicated that preoperative serum creatinine(OR=1.081,95%CI:1.042-1.122),low nasopharyngeal temperature during operation(OR=2.268,95%CI:1.291-4.016)and lactic acid level at an end of anesthesia(OR=2.643,95%CI:1.361-5.131)were independent determinants for the occurrence of delayed recovery(P<0.05).Receiver operating characteristic(ROC)curve was plotted by combining preoperative serum creatinine with lactate level after anesthesia.An area under the curve was 0.81(P<0.001)hinted at an excellent predictor for delayed postoperative recovery in NEC infants.Conclusion No single risk factor,rather a combination of factors may predict an onset of delayed recovery.Protection of vital organ functions,strengthening of heat preservation and maintenance of acid-base balance are important preventive measures of delayed recovery.

关 键 词：小肠结肠炎 坏死性 麻醉 全身 麻醉苏醒延迟 危险因素 婴儿 新生 

分 类 号：R574.5[医药卫生—消化系统] R614[医药卫生—内科学]