老年患者全身麻醉术后苏醒期躁动的logistic回归分析

Logistic analysis of risk factors for postoperative emergence agitation in elderly patients after general anesthesia

目的探讨老年患者全身麻醉术后苏醒期躁动的危险因素。方法选取2014年1月至2016年1月期间行全麻下手术治疗的住院患者230例,根据镇静-躁动(SAS)评分量表分为躁动组和非躁动组。收集所有患者的一般临床资料、麻醉和手术相关资料,首先进行单因素分析,再进行多因素logistic回归分析筛选出苏醒期躁动的危险因素。结果共有41例患者出现苏醒期躁动,苏醒期躁动的发生率为17.83%。单因素分析显示,两组患者在年龄、性别、高血压病史、留置胃管/导尿管、术前应用咪达唑仑、术中应用右美托咪定、麻醉维持方法、苏醒方式、术后镇痛等方面的差异具有统计学意义(P值分别为0.013、0.005、0.030、<0.001、0.038、0.004、0.002、0.008、0.028)。多因素logistic回归结果显示,男性(OR=3.020,95%CI 1.295-7.042)、留置胃管/导尿管(OR=4.213,95%CI 1.800-9.861)、单纯吸入维持麻醉(OR=2.918,95%CI 1.327-6.417)、药物催醒(OR=3.268,95%CI 1.136-9.404)是发生EA的危险因素,术中应用右美托咪定为保护因素(OR=0.323,95%CI 0.149-0.700)。结论男性、留置胃管/导尿管、单纯吸入维持麻醉、药物催醒是老年患者全麻后苏醒期躁动的危险因素,术中应用右美托咪定有助于减少苏醒期躁动的发生。

Objective To investigate associated risk factors for postoperative emergence agitation in general anesthe-sia.Methods 230 cases underwent general anesthesia were enrolled,and they were divided into 2 groups according to sedation-agitation scale.The clinical characteristics,operating and anesthetic indexes were collected.Risk factors for e-mergence agitation were analyzed using multivariate logistic regression.Results 41 cases were considered as emergence agitation and the prevalence of emergence agitation in elderly patients was 17.83%.Univariate analysis revealed that, there were significant differences in age,sex,history of hypertension,tracheal intubation/catheter,midazolam,dexme-detomidine,methods of maintaining anesthesia,recovery mode and postoperative analgesia （P=0.013,0.005,0.030,〈0.001,0.038,0.004,0.002,0.008,0.028,respectively）.The logistic regression analysis showed that,the risk factors for postoperative emergence agitation were male （OR=3.020,95%CI 1.295-7.042）,tracheal intubation/catheter （OR=4.213,95%CI 1.800-9.861）,inhalation anesthesia （OR=2.918,95%CI 1.327-6.417）and analeptic agents （OR=3.268,95%CI 1.136-9.404）,while intranperative dexmedetomidine was a protective factor （OR=0.323,95%CI 0.149-0.700）.Conclusion The risk factors for postoperative emergence agitation were male,tracheal intubation/cathe-ter,inhalation anesthesia and analeptic agents,while giving dexmedetomidine during operation may reduce the incidence.