小儿全身麻醉苏醒期躁动的危险因素分析

Risk Factors Analysis of Emergence Agitation in Children after General Anesthesia and Surgery

【目的】探讨小儿手术患者全身麻醉苏醒期躁动的危险因素。【方法】选择小儿全身麻醉患者410例,按照镇静躁动分级法对其苏醒状况进行评分,排除4分以下的患儿,对余下165例患儿的相关病史及麻醉病历分别作单因素和多因素logistic回归分析,评价小儿全身麻醉苏醒期躁动相关危险因素。【结果】单因素分析发现:手术史、手术大小、术后疼痛、麻醉维持方式、右美托咪啶、氯胺酮、曲马多、术后镇痛与躁动的发生相关(P<0.05)。多因素分析发现:年龄、术前焦虑、手术大小、术后疼痛、麻醉维持方式、右美托咪啶、留置尿管、术后镇痛等与躁动发生相关(P<0.05)。性别、性格、留置胃管、中心静脉置管、手术时间、拮抗、吸痰和腹腔镜手术与躁动发生无关(P>0.05)。【结论】小儿麻醉患者中学龄前儿童、术前焦虑、中等以上手术、全凭七氟醚吸入麻醉维持、留置尿管及术后疼痛患儿的术后躁动发生率显著增高。

[Objective] To analyze the risk factors of emergence agitation in children after general anesthesia and surgery. [Methods] A total of 410 children after general anesthesia were enrolled in the study. The level of emergence agitation was scored by SAS （sedation-agitation scale）. Children with SAS 〈4 were excluded. We analyzed the rest 165 children with univariate and multivariate logistic regression of risk factors of emergence agitation in children after general anesthesia. [Results] We found that univariate analysis revealed that surgery history, surgery type, postoperative pain, anesthesia maintenance method, dexmedetomidine, ketamine, tramadol, postoperative analgesia were significantly correlated with the incidence of agitation （P 〈 0.05）. Multivariate analysis revealed that age, preoperative anxiety, surgery type, postoperative pain, anesthesia maintenance method, dexmedetomidine, urinary catheterization, and postoperative analgesia were related with agitation in children （P 〈 0.05）. The factors of sex, character, gastric tube and urinary catheterization, central venous catheterization, surgery time, antagonist, suction, laparoscopic surgery were not associate with emergence agitation in children after general anesthesia. [Conclusion] In children after general anesthesia, the factors of preschool children, preoperative anxiety, anesthesia maintenance with sevoflurane alone, urinary catheterization, postoperative pain are associate with high incidence of emergence agitation after general anesthesia and surgery.