老年气管插管全身麻醉术后患者麻醉苏醒延迟的危险因素及护理对策  

Risk Factors of Delayed Awakening from Anesthesia and Nursing Countermeasures in Elderly Patients after General Anesthesia with Tracheal Intubation

作　　者：奚雨霞 管丽芬[1] Xi Yuxia;Guan Lifen(Taizhou Hospital of Zhejiang Province,Taizhou Zhejiang 317000,China)

机构地区：[1]浙江省台州医院,浙江台州317000

出　　处：《医疗装备》2023年第19期133-136,139,共5页Medical Equipment

摘　　要：目的分析老年气管插管全身麻醉术后患者麻醉苏醒延迟的危险因素,并针对性提出护理干预建议。方法回顾性分析2022年1月至2023年1月医院收治的100例老年气管插管全身麻醉术后患者的临床资料,根据是否发生苏醒延迟分为苏醒延迟组与非苏醒延迟组。通过单因素分析及多因素Logistic回归法分析麻醉苏醒延迟的危险因素。构建风险预测模型,采用受试者工作特征(ROC)曲线及曲线下面积(AUC)预测模型效能。结果老年气管插管全身麻醉术后患者麻醉苏醒延迟的发生率为23%(23/100)。多因素Logistic回归分析结果显示,年龄>70岁、美国麻醉医师协会(ASA)分级为Ⅲ级、手术时长>3 h、术中输注液体量>1500 ml、急诊手术、最低鼻咽温度<36℃、丙泊酚剂量>18 mg/kg、术中输血量>500 ml、术前合并认知功能障碍均为老年气管插管全身麻醉术后患者麻醉苏醒延迟的独立危险因素(P<0.05)。拟合优度校验和ROC曲线分析结果显示,χ^(2)=6.050,P=0.418,提示风险预测模型拟合度良好。AUC为0.904,95%CI为0.864~0.944,提示模型判别效果良好。约登指数最大为0.655,灵敏度为0.889,特异度为0.766,预测模型的最佳临界值为0.655。结论老年气管插管全身麻醉术后患者发生苏醒延迟的风险较高,临床应根据相关危险因素制定个性化护理措施,以改善患者预后。Objective To analyze the risk factors triggering delayed awakening after tracheal intubation general anesthesia in the elderly,and to propose the targeted nursing interventions were proposed.Methods The clinical data of 100 elderly patients admitted to the hospital of general anesthesia with tracheal intubation between January 2022 and January 2023 were retrospectively analyzed,and they were divided into a delayed awakening group and a non-delayed awakening group according to the happen status of delayed awakening.The risk factors for delayed awakening were evaluated by single-factor and multi-factor Logistic regression analysis.A risk prediction model was constructed,and the receiver operator characteristic(ROC)curve and area under the curve(AUC)were used to predict model performance.Results The probability of delayed awakening from anesthesia after general anesthesia with tracheal intubation in the elderly was 23%(23/100).The results of multi-factor Logistic regression analysis showed that patients'age>70 years old,American Society of Anesthesiologists(ASA)GradeⅢ,duration of surgery>3 hours,intraoperative fluid volume>1500 ml,emergency operation,minimum nasopharyngeal temperature<36℃,propofol dose>18 mg/kg,intraoperative blood transfusion volume>500 ml,and preoperative combined cognitive dysfunction were independent risk factors for delayed awakening from anesthesia after general anesthesia with tracheal intubation in the elderly(P<0.05).The goodness-of-fit calibration and ROC curve analysis showed thatχ^(2) was 6.050 and P was 0.418,suggesting a good fit of the risk prediction model.AUC was 0.904 and 95%CI was 0.864~0.944,indicating good model discrimination.The maximum Youden index was 0.655,the sensitivity was 0.889,and the specificity was 0.766,and the best critical value of the prediction model was 0.655.Conclusion The likelihood of delayed awakening after general anesthesia with tracheal intubation in the elderly is high,and clinical care should be individualized according to risk factors to help pat

关 键 词：老年患者 气管插管 麻醉苏醒延迟 护理 

分 类 号：R473.5[医药卫生—护理学]