肝切除术患者麻醉后苏醒延迟的影响因素分析  

Analysis of influencing factors of delayed recovery afteRanesthesia in patients undergoing hepatectomy

作　　者：庞金东 鲁显福[2] 李元海[1] PANG Jindong;LU Xianfu;LI Yuanhai(Department of Anesthesiology,Chaohu Hospital of Anhui Medical University,Chaohu,Anhui 238000,China)

机构地区：[1]安徽医科大学附属巢湖医院麻醉科,安徽巢湖238000 [2]安徽医科大学第一附属医院高新院区麻醉科,安徽合肥230022

出　　处：《淮海医药》2023年第2期128-132,共5页Journal of Huaihai Medicine

摘　　要：目的:探讨肝切除术患者麻醉后发生苏醒延迟的相关影响因素。方法:选取2020年4月—2022年5月某院行肝切除术的患者410例为研究对象,根据麻醉后是否发生苏醒延迟将患者分为苏醒延迟组(33例)和非苏醒延迟组(377例)。比较2组间性别、年龄、BMI、ASA分级、术前衰弱、吸烟史、饮酒史、手术史、既往病史、术前检验指标、肝功能Child-Pugh分级、肿瘤情况、手术方式、麻醉时间、肝门阻断时间、丙泊酚用量、顺式阿曲库铵用量、硬膜外局麻药用量、术中低体温、术中持续使用升压药、术中输血、输液量、尿量、术后动脉血气指标,采用多因素Logistic回归方程分析肝切除术患者麻醉后苏醒延迟的影响因素,并建立风险预测模型,绘制ROC曲线分析其预测价值。结果:单因素分析显示,2组间性别、ASA分级、吸烟史、饮酒史、手术史、既往病史、总胆红素、谷丙转氨酶、谷草转氨酶、血红蛋白、肌酐、肝功能Child-Pugh分级、肿瘤情况、手术方式、肝门阻断时间、硬膜外局麻药用量、术中低体温、术中持续使用升压药、术中输血、输液量、尿量、术后低钠血症及术后血糖比较,差异均无统计学意义(P>0.05);苏醒延迟组BMI、术前白蛋白水平低于非苏醒延迟组(P<0.05),年龄、术前衰弱比例、凝血酶原时间、麻醉时间、丙泊酚用量、顺式阿曲库铵用量、术后酸血症比例、术后低钾血症比例、术后低钙血症比例及术后乳酸水平高于非苏醒延迟组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,高BMI是肝切除术后苏醒延迟的保护因素(OR=0.811,95%CI=0.699~0.940,P=0.005),术前衰弱是肝切除术后患者苏醒延迟的危险因素(OR=3.167,95%CI=1.124~8.918,P=0.029)。ROC曲线显示,AUC为0.854(95%CI=0.796~0.912),灵敏度为87.9%,特异度为71.5%,最大约登指数为0.594。结论:高BMI是肝切除术后发生苏醒延迟的保护因素,Objective:To explore the related influencing factors of delayed recovery afteRanesthesia in patients undergoing hepatectomy.Methods:A total of 410 patients undergoing hepatectomy from April 2020 to May 2022 were collected.According to whetheRthere was delayed recovery afteRanesthesia,the patients were divided into two groups:delayed recovery group(33 cases)and non-delayed recovery group(377 cases).Statistically significant variables were included in the binary logistic regression model to analyze the influencing factors of the recovery delay afteRanesthesia in those patients and establish a risk prediction model.Results:Univariate analysis showed that the body mass index(BMI)and preoperative albumin of the patients in the delayed recovery group were significantly loweRthan those in the non-delayed recovery group(P<0.05).Age,preoperative frailty ratio,prothrombin time,anesthesia time,propofol and cisatracurium dosage,postoperative acidemia ratio,hypokalemia ratio,hypocalcemia ratio,and postoperative lactic acid content of the patients in the delayed recovery group were significantly higheRthan those in the non-delayed recovery group(P<0.05).Multivariate logistic regression analysis showed that high BMI was a protective factoRfoRdelayed recovery afteRhepatectomy(OR=0.811,95%CI=0.699~0.940,P=0.005),and preoperative frailty was a risk factoRfoRdelayed recovery afteRhepatectomy(OR=3.167,95%CI=1.124~8.918,P=0.029).The area undeRthe curve of the ROC curve of the established risk prediction model was 0.854(95%CI 0.796~0.912,P<0.001),the sensitivity was 87.9%,the specificity was 71.5%,and the maximum Youdon index was 0.594.Conclusion:High BMI is a protective factoRfoRdelayed recovery afteRhepatectomy,and preoperative frailty is a risk factoRfoRdelayed recovery afteRhepatectomy.

关 键 词：麻醉苏醒延迟 肝切除术 衰弱 BMI 影响因素 

分 类 号：R619[医药卫生—外科学]