Aldrete评分、Steward评分、OAA/S评分在日间胸腔镜手术全麻术后苏醒的应用价值对比  

Comparison of the application value of Aldrete score,Steward score,and Observer's Assessment of Alterness/Sedation score in recovery after daytime thoracoscopic surgery under general anesthesia

作　　者：曹雁 陈雪 刘胡青 刘小娟 Cao Yan;Chen Xue;Liu Huqing;Liu Xiaojuan(Department of Anesthesiology,Shanghai Pulmonary Hospital,Shanghai 200433,China)

机构地区：[1]上海市肺科医院麻醉科,上海200433

出　　处：《国际麻醉学与复苏杂志》2022年第9期944-949,共6页International Journal of Anesthesiology and Resuscitation

基　　金：上海市肺科医院院级课题(HL2009)。

摘　　要：目的探究Aldrete评分、Steward评分、警觉与镇静(Observer’s Assessment of Alterness/Sedation,OAA/S)评分在日间胸腔镜手术患者全麻术后苏醒延迟中的临床诊断效能。方法选取2020年1月至2021年6月在上海市肺科医院行全麻下日间胸腔镜手术患者600例,依据苏醒延长时间判定苏醒延迟情况,将患者纳入苏醒时间延迟组(200例)和苏醒时间未延迟组(400例)。采用单因素分析评价日间胸腔镜手术患者苏醒时间延迟在临床资料上的差异,多因素Logistic回归分析日间胸腔镜手术患者苏醒时间延迟的影响因素,分别采用Aldrete评分、Steward评分、OAA/S评分对患者苏醒情况进行评估,对比两组患者评分差异,绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析3项评分评估日间胸腔镜手术患者苏醒时间延迟的临床效能。结果日间胸腔镜手术患者的苏醒时间延迟在年龄、低体温、低血压、低血糖、高碳酸血症、手术时间及出血量情况上差异有统计学意义(P<0.001)。低血糖、低血压、出血量≥200 ml、手术时间≥4 h、高碳酸血症、年龄≥60岁、低体温是日间胸腔镜手术患者苏醒时间延迟的危险因素。与苏醒时间未延迟组比较,苏醒时间延迟组患者的Aldrete评分、Steward评分、OAA/S评分均明显降低(P<0.05)。Aldrete评分、Steward评分、OAA/S评分评估苏醒时间延迟的曲线下面积(area under curve,AUC)分别为0.966、0.855和0.720。结论低血糖、低血压、出血量≥200 ml、手术时间≥4 h、高碳酸血症、年龄≥60岁、低体温是全麻下日间胸腔镜手术患者术后苏醒延迟的危险因素,Aldrete评分在评估麻醉术后苏醒时间中的临床效能高于Steward评分、OAA/S评分。Objective To explore the clinical diagnostic efficacy of Aldrete score,Steward score and Observer's Assessment of Alterness/Sedation(OAA/S)score in delayed recovery after general anesthesia in patients undergoing daytime thoracoscopic surgery.Methods Choose between January 2020 and June 2021 in Shanghai Pulmonary Hospital daytime thoracoscope surgery under general anesthesia,600 cases of patients,according to the decision to extend the time delays,divided into the awakening time delay group(n=200)and the awakening time not delay group(n=400),using the single factor analysis of thoracoscope surgery patients regained consciousness in the day time delay in the differences of clinical data,multivariate logistic regression analysis was used to analyze the influencing factors of recovery time delay in patients undergoing daytime thoracoscopic surgery.Aldrete score,Steward score and OAA/S score were used to evaluate the recovery situation of 600 patients,and the difference of recovery time score between the awakening time delay group and the awakening time not delay group was compared.Receiver operating characteristic(ROC)curve was drawn to analyze the clinical efficacy of Aldrete score,Steward score and OAA/S score in evaluating the recovery time delay of patients undergoing amboscope thoracoscopic surgery.Results There were significant differences in age,hypothermia,hypotension,hypoglycemia,hypercapnia,operation time and blood loss(P<0.001).Hypoglycemia,hypotension,blood loss≥200 ml,operation time≥4 h,hypercapnia,age≥60 years,and hypothermia are risk factors for delayed recovery time in patients undergoing ambulatorthoracoscopic surgery.Compared with the awakening time not delay group,the Aldrete score,Steward score,and OAA/S score of patients in the awakening time delay group were significantly lower(P<0.05).The area under curve(AUC)of Aldrete score,Steward score and OAA/s score were 0.966,0.855 and 0.720.Conclusions Hypoglycemia,hypotension,blood loss≥200 ml,operation time≥4 h,hypercapnia,age≥60 years,an

关 键 词：Aldrete评分 Steward评分 警觉/镇静评分 日间手术 胸腔镜手术 麻醉 全身 术后苏醒 

分 类 号：R614.2[医药卫生—麻醉学]