神经外科患者麻醉恢复期常见并发症及危险因素分析

Postoperative Complications and Related Risk Factors in Neurosurgery Patients during Anesthesia Recovery

目的探讨神经外科患者麻醉恢复期常见并发症的发生情况及其相关危险因素。方法回顾性分析2010年3月~2014年11月期间麻醉恢复室神经外科全麻术后的患者,患者信息和并发症情况按统一标准由专人记录。并发症包括呼吸系统和循环系统并发症、恶心呕吐、疼痛、寒战、躁动及苏醒延迟。采用多因素Logistic回归分析,筛选并发症的危险因素。结果 13,495例患者并发症总发生率为48.8%。常见并发症包括术后恶心呕吐（PONV）、高血压、心律失常、躁动、寒战、疼痛、低氧血症、苏醒延迟、呼吸道梗阻和低血压,发生率分别为14.5%、13.5%、13.4%、9.3%、8.9%、5.9%、2.5%、1.9%、1.7%、0.3%。回归分析显示低氧血症的危险因素包括男性、年龄59岁以下、幕下肿瘤（P〈0.05）。PONV的危险因素包括男性、幕上肿瘤、幕下肿瘤、脑血管病、静吸复合麻醉,术毕使用曲马多和肌松拮抗药（P〈0.05）。术后躁动的危险因素包括男性、幕下肿瘤和脑血管病、静吸复合麻醉、使用肌松药拮抗和未使用患者自控镇痛（PCA）泵（P〈0.05）。结论不同神经外科疾病患者术后常见并发症的发生情况不同,并发症的危险因素亦有区别。麻醉医师需针对不同的神经外科手术,严密监测并及时治疗。

Objective To investigate the characteristics of postoperative complications and related risk factors in neurosurgery patients.Methods A retrospective study was carried out in neurosurgery patients during anesthesia recovery period from March,2009 to November,2013.The recorded complications included respiratory and circulatory system complications,pain,shivering,nausea and vomiting,agitation and delaying recovery.Multivariate logistic regression analysis was performed to screen the risk factors for these complications.Results Data of 13,495 patients were available for analysis.The general incidence was 48.8%.Post-operative complications included post-operative nausea and vomiting（PONV）（14.5%）,agitation（13.5%）,hypertension（13.4%）,arrhythmia（9.3%）,shivering（8.9%）,pain（5.9%）,hypoxemia（2.5%）,delayed recovery（1.9%）,airway obstruction（1.7%） and hypotension（0.3%）.Regression analysis showed that the risk factors for hypoxemia included male,59 years old and infratentorial tumor（P〈0.05）;the risk factors for PONV included male,supratentorial tumor,infratentorial tumor,cerebrovascular disease,inhalation anesthesia,the use of muscle relaxants antagonism and tramadol（P〈0.05）;and the risk factors for postoperative restlessness included male,infratentorial tumor and cerebrovascular disease,inhalation anesthesia,the use of muscle relaxants antagonism and no use of patient-controlled analgesia（PCA） pump（P〈0.05）.Conclusion Patients with different neurological diseases showed different post-operative complications and exhibited different risk factors for these complications.Anesthesiologists should closely monitor patients receiving various neurosurgery and provide timely treatment.