麻醉恢复室全身麻醉患者转出延迟的影响因素分析

Analysis of factors affecting delayed transfer of patients under general anesthesia from the post-anesthesia care unit

摘要:

目的 探讨影响麻醉恢复室（PACU）全身麻醉患者转出延迟的主要因素。方法 收集PACU全身麻醉（以下简称全麻）转出延迟患者105例，采用1∶2匹配设计，选出符合条件的对照组210例，利用中南大学湘雅三医院临床医疗信息系统及麻醉临床信息系统收集患者各类临床手术相关数据。结果 单因素一般Logistic回归分析结果显示：术前Cl^-、平均动脉压（MAP）、MAP> 130 mmHg时间、全手术期平均心率、最高心率、全手术期总入量、全手术期总出量、输血量、PACU再使用阿片类止痛药、总去甲肾上腺素剂量、是否使用升压药物、术后动脉血二氧化碳分压（PaCO₂）、术中动脉血氧分压、术中Na⁺、术后Glu均是PACU全麻患者转出延迟的危险因素（P <0.05）。多因素逐步Logistic回归分析结果显示：术中Na⁺［O^R=1.137（95% CI：1.056，1.223）］、术后PaCO₂ ［O^R=3.602（95% CI：1.693，7.681）］、PACU再使用阿片类药物［O^R=2.950（95% CI：1.460，5.959）］均是PACU全麻患者转出延迟的独立危险因素（P <0.05）。结论 及时监测术中Na⁺、术后PaCO₂、PACU再使用阿片类药物及早期干预可降低PACU转出延迟发生率。

Abstract:

Objective To analyze the main factors affecting delayed transfer of patients under general anesthesia from the post-anesthesia care unit (PACU).Methods A total of 105 cases with delayed transfer were collected, and another 210 cases were selected as the control group by a 1:2 matching design. Patient clinical and surgery-related data were collected using the clinical medical information system and anesthesia clinical information system of the Xiangya Third Hospital of Central South University.Results The results of univariable Logistic regression analysis showed that preoperative Cl^-, the highest MAP, the duration of MAP > 130 mmHg, the average heart rate during the entire operation, the highest heart rate, total fluid input during the entire operation, total fluid output during the entire operation, blood transfusion volume, use of opioid analgesics in PACU, the total dosage of norepinephrine, use of vasoactive drugs, postoperative PaCO₂, intraoperative PaO₂, intraoperative Na⁺, and postoperative Glu were all risk factors for delayed transfer of patients under general anesthesia from the PACU (P < 0.05). The stepwise multivariable Logistic regression analysis revealed that intraoperative Na⁺ [O^R = 1.137 (95% CI: 1.056, 1.223) ], postoperative PaCO₂ [O^R = 3.602 (95% CI: 1.693, 7.681) ], and use of opioid analgesics in PACU [O^R = 2.950 (95% CI: 1.460, 5.959) ] were all independent risk factors for delayed transfer of patients under general anesthesia from the PACU (P < 0.05).Conclusions Timely monitoring of intraoperative Na⁺, postoperative PaCO₂, and use of opioid analgesics in PACU, along with early interventions, can reduce the incidence of delayed transfer from the PACU.