麻醉后监护病房改良Steward评分法的建立与临床评估  

Establishment and clinical evaluation of modified Steward recovery scoring in post-anesthesia care unit

作　　者：刘贺 曹月 李冰 李璐 张加强 武江霞 LIU He;CAO Yue;LI Bing;LI Lu;ZHANG Jiaqiang;WU Jiangxia(Department of Anesthesiology and Perioperative Medicine,Henan Provincial People’s Hospital,Zhengzhou University People’s Hospital,Zhengzhou,Henan 450003,China;Department of Anesthesiology,Luoyang Orthopedic Hospital of Henan Province,Henan Provincial Orthopedic Hospital,Zhengzhou,Henan 450016,China)

机构地区：[1]河南省人民医院麻醉与围术期医学科,郑州大学人民医院,河南郑州450003 [2]河南省洛阳正骨医院,河南省骨科医院麻醉科,河南郑州450016

出　　处：《中华实用诊断与治疗杂志》2024年第12期1242-1246,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20200059)。

摘　　要：目的观察行全身麻醉下手术后入麻醉后监护病房(PACU)患者拔气管插管或喉罩后(拔管后)24 h内Steward>4分后低氧血症发生情况,建立并验证改良Steward评分法,探讨更安全的PACU转出标准。方法2020年2—6月河南省人民医院行全身麻醉下手术后入PACU患者601例,记录拔管后24 h内Steward评分>4分后低氧血症发生情况及Steward评分>4分至首次发生低氧血症的时间,并据此建立PACU转出标准的改良Steward评分法。2020年10—12月河南省人民医院行全身麻醉下手术后入PACU患者1156例,随机分为Steward组和改良Steward组各578例,分别采用Steward评分>4分和改良Steward评分法作为PACU转出标准,记录2组拔管后24 h内达到PACU转出标准后低氧血症发生情况。结果601例患者手术时间(145.6±98.8)min,术中舒芬太尼用量(40.8±6.8)μg,拔管后24 h内Steward评分>4分后发生低氧血症101例(16.81%),其中轻度低氧血症17例(16.83%),中重度低氧血症84例(83.17%);拔管后24 h内Steward评分>4分至首次发生低氧血症的时间为(4.21±1.89)min,均<10 min;据此建立PACU转出标准的改良Steward评分法为完全清醒+肢体有意识活动+拔管后不吸氧情况下10 min无低氧血症发生。拔管后24 h内达到PACU转出标准后,改良Steward组发生轻度低氧血症8例,Steward组发生轻度低氧血症137例;改良Steward组低氧血症发生率(1.38%)低于Steward组(23.70%)(χ^(2)=131.225,P<0.001)。结论行全身麻醉下手术后入PACU患者采用改良Steward评分法作为PACU转出标准优于Steward评分法,可降低术后24 h低氧血症发生率。Objective To observe the occurrence of hypoxemia after Steward recovery score is over 4within 24hafter the removal of endotracheal intubation or laryngeal mask(after extubation)in post-anesthesia care unit(PACU)patients after surgery under general anesthesia,to establish and validate a modified Steward recovery scoring,and to explore safer PACU discharge criteria.Methods From February to June 2020,601patients undergoing surgery under general anesthesia were admitted to PACU in Henan Provincial People’s Hospital.The occurrence of hypoxemia after Steward recovery score reaching over 4within 24hafter extubation and the period from Steward recovery score reaching over 4to the first occurrence of hypoxemia were recorded,by which the modified Steward recovery scoring method was established.Another 1156patients in PACU after surgery under general anesthesia in Henan Provincial People’s Hospital from October to December 2020were randomly and equally divided into the Steward group and the modified Steward group.The Steward recovery score reaching over 4and modified Steward recovery scoring method were used as PACU discharge criteria respectively.The occurrence of hypoxemia after meeting the PACU discharge criteria within 24h after extubation was recorded in two groups.Results In 601patients,the surgery time was(145.6±98.8)min,the intrasurgical sufentanil dosage was(40.8±6.8)μg,and 101patients(16.81%)developed hypoxemia after Steward recovery score reaching over 4within 24hafter extubation,including 17cases(16.83%)of mild hypoxemia and 84cases(83.17%)of moderate or severe hypoxemia.It took(4.21±1.89)min(all<10min)from Steward recovery score reaching over 4within 24hafter extubation to the first occurrence of hypoxemia.The modified Steward recovery scoring method for establishing PACU discharge criteria was awake+moving limbs purposefully+no occurrence of hypoxemia within 10min after extubation without oxygen inhalation.After meeting the PACU discharge criteria within 24hafter extubation,mild hypoxemia occurred in 8

关 键 词：麻醉质控 麻醉后监护病房转出标准 Steward评分法 改良Steward评分法 低氧血症 

分 类 号：R614[医药卫生—麻醉学]