摘要
目的探讨胸科手术患者麻醉苏醒期躁动的危险因素,以及麻醉清醒前是否拔除导尿管的影响。方法回顾2018年1月至2020年1月湖州市中心医院胸科接受气管插管全身麻醉的150例患者,根据麻醉苏醒期是否发生躁动分为躁动组与无躁动组,比较两组患者的临床资料,并分析影响胸科手术患者麻醉苏醒期躁动的危险因素。根据患者是否在麻醉清醒前拔除导尿管将患者分为麻醉清醒前拔除导尿管(观察组)和麻醉清醒前未拔除导尿管(对照组),比较两组患者术后尿潴留发生率、尿道刺激发生率、躁动发生率、舒适度评分、疼痛评分、术后麻醉苏醒时间的差异。结果150例胸科手术患者中麻醉苏醒期发生躁动23例,躁动发生率为15.3%。经单因素、多因素logistic回归分析发现,手术时间≥120 min、术中出血量≥200 ml、术后无镇痛、麻醉诱导后留置导尿管、肌松药物残留、麻醉清醒后拔除导尿管是导致胸科手术患者麻醉苏醒期发生躁动的独立危险因素(均P<0.05)。150例患者中观察组93例,对照组57例,观察组尿道刺激发生率、躁动发生率均低于对照组(均P<0.05),而两组患者尿潴留发生率比较差异无统计学意义(P>0.05)。观察组术后1、2、3 d的舒适度评分均高于对照组,而疼痛评分均低于对照组(均P<0.05)。与对照组比较,观察组术后自主呼吸恢复时间、睁眼时间、指令恢复时间均明显更短(均P<0.05)。结论手术时间≥120 min、术中出血量≥200 ml、术后无镇痛、麻醉诱导后留置导尿管、肌松药物残留、麻醉清醒后拔除导尿管是导致胸科手术患者麻醉苏醒期发生躁动的独立危险因素,而麻醉清醒前拔除导尿管可减少术后躁动、减轻尿道刺激,提升患者躯体舒适度,有利于加快患者苏醒。
Objective To explore the risk factors of postoperative agitation in patients undergoing anesthesia for thoracic surgery.Methods Clinical data of 150 patients who underwent general anesthesia for thoracic surgery in Huzhou Central Hospital from January 2018 to January 2020 were retrospectively reviewed.The agitation occurred during the anesthesia recovery period in 23 cases(15.3%).The risk factors of postoperative agitation in patients undergoing anesthesia for thoracic surgery were analyzed.The urinary catheter was removed before awakening in 93 cases(catheter removing group)and the urinary catheter was not removed in 57 cases(control group).The incidence of postoperative urinary retention,urethral irritation,postoperative agitation,comfort score,pain score,postoperative anesthesia recovery time were compared between two groups.Results The univariate and multivariate logistic regression analysis showed that operation time≥120 min,intraoperative blood loss≥200 ml,no postoperative analgesia,indwelling urinary catheter after anesthesia induction,muscle relaxant drug remained,and the removing urinary catheter after anesthesia awakening were risk factors of postoperative agitation in patients undergoing anesthesia for thoracic surgery(all P<0.05).The incidence of urethral irritation and postoperative agitation in the catheter removing group were lower than that in the control group(both P<0.05),while there was no significant difference in the incidence of urinary retention between the two groups(P>0.05).The comfort scores of the catheter removing group were higher than those of the control group at 1,2,and 3 days after surgery,while the pain scores were lower than those of the control group(all P<0.05).Compared with the control group,the postoperative spontaneous breathing recovery time,eye-opening time,and command recovery time of catheter removing group were significantly shorter(all P<0.05).Conclusion Operation time≥120 min,intraoperative blood loss≥200 ml,no postoperative analgesia,indwelling catheter afte
作者
姚博炜
高斌
楼能
YAO Bowei;GAO Bin;LOU Neng(不详;Department of Anesthesiology,Huzhou Central Hospital,Huzhou 313000,China)
出处
《浙江医学》
CAS
2022年第1期64-67,共4页
Zhejiang Medical Journal
关键词
胸科手术
麻醉苏醒期
躁动
影响因素
拔管
Thoracic surgery
Recovery from anesthesia
Restlessness
Influencing factors
Extubation
