肥胖患者胃减容术后麻醉恢复室延迟转出的危险因素分析  

Analysis of risk factors for delayed leaving postanesthesia care unit after bariatric surgery in obese patients

作　　者：王敏[1] 范婧婧 许一凡 陈晓东 许佩龙 WANG Min;FAN Jingjing;XU Yifan;CHEN Xiaodong;XU Peilong(Department of Anesthesiology and Perioperative Medicine,First Affiliated Hospital,Nanjing Medical University,Nanjing 210029,CHINA)

机构地区：[1]南京医科大学第一附属医院麻醉与围术期医学科,江苏210029

出　　处：《江苏医药》2024年第10期1020-1024,共5页Jiangsu Medical Journal

摘　　要：目的分析肥胖患者胃减容术后麻醉恢复室(PACU)延迟转出的危险因素。方法回顾性分析1220例择期行腹腔镜胃减容术肥胖患者的临床资料。其中,163例患者PACU停留时间≥120min(延迟组),1057例患者PACU停留时间<120min(非延迟组)。采用倾向性评分匹配和多因素logistic回归分析胃减容术患者发生PACU延迟转出的相关危险因素。结果将性别、年龄、体重、BMI、病态肥胖、美国麻醉医师协会分级、吸烟史和术前合并症作为协变量进行倾向性评分匹配。与非延迟组相比,延迟组舒芬太尼用量、补液总量、出血量增加,停肌松药至手术结束时间、拔管时间延长,PACU补救镇痛比例及苏醒期低氧血症发生率升高(P<0.05)。多因素logistic回归分析结果显示,拔管时间延长[OR=1.085,95%CI(1.059~1.111),P<0.05]、PACU补救镇痛[OR=6.537,95%CI(1.992~21.452),P<0.05]和苏醒期低氧血症[OR=8.598,95%CI(4.501~16.426),P<0.05]是PACU延迟转出的独立危险因素。结论拔管时间延长、PACU补救镇痛和苏醒期低氧血症是肥胖患者腹腔镜胃减容术后PACU延迟转出的独立危险因素。Objective To analyze the risk factors for delayed leaving postanesthesia care unit(PACU)after laparoscopic bariatric surgery in obese patients.Methods The clinical data of 1220 obese patients underwent laparoscopic bariatric surgery were analyzed retrospectively,of whom 163 cases had the PACU stay time of≥120minutes(group A)and 1057 cases had the PACU stay time of<120minutes(group B).Propensity score matching and multivariate logistic regression were used to analyze the risk factors of delayed leaving PACU after laparoscopic bariatric surgery in obese patients.Results Propensity score matching was performed based on preoperative factors including gender,age,weight,BMI,morbid obesity,ASA classification,smoking history and preoperative complications.Compared with group B,the dosage of sufentanil,total volume of fluid infusion,volume of blood loss were increased,time from the end of surgery to withdrawing muscle relaxant and extubation time were prolonged,and the proportion of rescue analgesia use and incidence of hypoxemia were increased in group A(P<0.05).Multivariate logistic regression analysis showed that extubation time prolongation[OR=1.085,95%CI(1.059-1.111),P<0.05],rescue analgesia use in PACU[OR=6.537,95%CI(1.992-21.452),P<0.05],and hypoxemia during anesthesia recovery[OR=8.598,95%CI(4.501-16.426),P<0.05]were the independent factors for delayed leaving PACU.Conclusion Extubation time prolongation,rescue analgesia use in PACU and hypoxemia during anesthesia recovery are the independent risk factors for delayed leaving PACU after laparoscopic bariatric surgery in obese patients.

关 键 词：肥胖 胃减容术 

分 类 号：R614[医药卫生—麻醉学]