全身麻醉下肝肿瘤切除术患者术后苏醒延迟的相关危险因素分析

发布时间：2018-04-01 12:33

本文选题：全身麻醉　切入点：肝肿瘤切除术　出处：《广西医科大学》2017年硕士论文

【摘要】：目的:通过对我院全麻下肝肿瘤切除术患者术后是否存在苏醒延迟的回顾性分析,探讨术中不同用药情况等相关因素对全麻下肝肿瘤切除术患者术后是否发生苏醒延迟的影响,为患者术后的快速康复提供参考依据。方法:本文数据选取自2014年至2016年广西医科大学第一附属医院东院手术室全麻下行肝肿瘤切除术的患者的电子病历、麻醉记录单以及复苏单。纳入者年龄在18岁至65岁之间,排除条件:数据不完整(如缺失部分血流动力学参数,术中未监测本文所需的数据类型,病历记录不全等),最终共纳入病例309例。运用Logistic回归分析对临床病例资料进行统计分析,探讨全麻下肝肿瘤切除术患者术后发生苏醒延迟的相关因素。结果:影响术后苏醒延迟发生的监测变量包括:患者的年龄、性别、体重、身高、肝功能分级、贫血、高血压、糖尿病、饮酒史、吸烟史、肺部疾病史、全麻史、麻醉时间、ASA分级、手术级别、是否复合吸入麻醉、是否复合硬膜外麻醉、术中丙泊酚、瑞芬太尼及芬太尼用量、术中总输液量、术中输血情况、是否采用BIS监测麻醉深度及术后即时体温共计24项。对以上变量进行单因素分析后,通过筛选(P0.05)选出具有统计学意义的变量行多因素Logistics回归分析,结果显示影响全麻下肝肿瘤切除术患者术后是否发生苏醒延迟的因素有9个,其差异均有统计学意义(P0.05)。按照OR值从大到小排序如下:丙泊酚用量(OR=4.073,P=0.023)、麻醉时长(OR=2.488,P=0.034)、年龄(OR=1.909,P=0.028)、术后即时体温(OR=1.893,P0.001)、饮酒(OR=1.658,P=0.03)、吸烟(OR=1.378,P=0.017)、贫血(OR=1.251,P=0.002)、术中输液总量(OR=1.177,P0.001)及BIS监测(OR=0.298,P0.001)。结论:1、随着肝肿瘤切除术患者的年龄、麻醉时长、术中输液量以及术中丙泊酚用量的的增加,发生术后苏醒延迟的风险增高。2、肝肿瘤切除术患者饮酒、吸烟、贫血、术中是否应用BIS监测以及术后低温是影响术后是否发生苏醒延迟的危险因素。
[Abstract]:Objective: to analyze retrospectively whether there is a delayed recovery in patients with liver tumor resection under general anesthesia in our hospital, and to explore the influence of different drugs during operation on the postoperative recovery delay of patients undergoing hepatectomy under general anesthesia. Methods: from 2014 to 2016, we selected the electronic medical records of patients undergoing hepatectomy under general anesthesia in the Eastern Hospital of the first affiliated Hospital of Guangxi Medical University. Anaesthesia record sheet and resuscitation sheet. The participants were between 18 and 65 years of age, exclusion conditions: incomplete data (such as missing partial hemodynamic parameters, lack of intraoperative monitoring of the data types required for this article), Incomplete medical records were recorded and 309 cases were included. The clinical data were statistically analyzed by Logistic regression analysis. Objective: to investigate the related factors of postoperative recovery delay in patients with liver tumor resection under general anesthesia. Results: age, sex, weight, height, grade of liver function, anemia, hypertension were the monitoring variables that affected the delayed recovery after operation, and the related factors were: age, sex, weight, height, grade of liver function, anemia, hypertension. Diabetes mellitus, history of alcohol consumption, history of smoking, history of lung disease, history of general anesthesia, time of anesthesia, ASA classification, surgical grade, compound inhalation anesthesia, combined epidural anesthesia, intraoperative propofol, remifentanil and fentanyl dosage, The total volume of infusion during operation, the blood transfusion during operation, whether the anesthetic depth and body temperature were monitored by BIS were 24 items. The multivariate Logistics regression analysis showed that there were 9 factors influencing the delayed recovery after hepatectomy under general anesthesia. The difference was statistically significant (P 0.05). According to OR value, the order was as follows: the dosage of propofol was 4.073P0. 023, the duration of anaesthesia was 2.488P0.034, the age was 1.909 P0. 028, the body temperature was OR1. 893P0. 001, the body temperature was OR1. 893P0. 001, drinking alcohol was 1. 658P0.03, smoking OR1.378P0. 017, anemic OR1.251P0. 002, the total volume of intraoperative infusion: OR1. 177p 0. 001and BIS monitoring OR1. 298P0. 001. conclusion: 1. Age of patients undergoing hepatectomy, The duration of anesthesia, the volume of intraoperative infusion and the dosage of propofol during operation, the risk of delayed recovery after operation were increased. Intraoperative BIS monitoring and postoperative hypothermia were risk factors for delayed recovery.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614;R735.7

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