神经外科手术患者全身麻醉后苏醒延迟的危险因素分析

Risk factors analysis of patients with delayed emergence from general anesthesia after neurosurgical craniotomy

目的探讨神经外科手术患者全身麻醉后苏醒延迟的发生率及其危险因素。方法回顾性分析2015年1月—2020年6月于首都医科大学附属北京天坛医院行神经外科手术的11878例患者的临床资料。所有患者术前意识清醒,在术中接受全身麻醉及机械通气,手术室内拔除气管插管后转入PACU,记录术后早期意识及生命体征状态。根据患者年龄(±2岁)、性别及手术日期(±14 d),按1∶1的比例为苏醒延迟的病例匹配对照病例,分别纳入苏醒延迟组(107例)和对照组(107例)。对组间比较差异有统计学意义的变量进行单因素Logistic回归,将单因素分析中P<0.05的临床因素纳入多因素Logistic回归模型中,分析脑肿瘤切除术术后苏醒延迟的危险因素。结果11878例脑肿瘤切除术患者中,术后苏醒延迟的发生率为0.9%。苏醒延迟组患者BMI<25 kg/m^(2)、术前ASA分级Ⅲ-Ⅳ级、术前卡氏功能状态评分(Karnofsky Performance Status Scale,KPS)<80分、肿瘤最大直径>4 cm、WHO病理分级Ⅲ-Ⅳ级、手术时长>4 h的占比等高于对照组,舒芬太尼用量少于对照组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,BMI<25 kg/m^(2)[比值比(odds ratio,OR)=0.451,95%CI 0.238~0.854,P=0.015]、术前KPS评分<80分(OR=3.449,95%CI 1.282~9.279,P=0.014)、WHO病理分级Ⅲ-Ⅳ级(OR=3.499,95%CI 1.744~7.018,P<0.001)、手术时长>4 h(OR=4.623,95%CI 2.425~8.816,P<0.001)是脑肿瘤切除术术后苏醒延迟的危险因素(P<0.05)。结论脑肿瘤切除术术后苏醒延迟并不罕见,BMI<25 kg/m^(2)、术前KPS评分<80分、WHO病理分级Ⅲ-Ⅳ级、手术时长>4 h是脑肿瘤切除术术后苏醒延迟的危险因素.

Objective To investigate the incidence of delayed emergence from general anesthesia after neurosurgical craniotomy.Methods A total of 11,878 patients who underwent neurosurgery in Beijing Tiantan Hospital from Jan 2015 to Jun 2020 were enrolled and their clinical data were retrospectively analyzed.All the patients were conscious before surgery,and then received general anesthesia and mechanical ventilation during craniotomy.After surgery,tracheal extubation was performed in the operating room before admission to the post-anesthesia care unit.Postoperative consciousness and vital signs were recorded.According to their age(±2 years),sex and date of surgery(±14 d),patients with delayed emergence were matched at a ratio of 1∶1,and were then divided into two groups(n=107):a delayed emergence group and a control group.Single-factor Logistic regression was performed on variables with statistical differences between the groups,and variables with P<0.05 in the single-factor regression were included in the multivariate Logistic regression to explore the related risk factors of delayed recovery after brain tumor resection.Results The incidence of delayed emergence was 0.9%(107/11878).The delayed emergence group presented increases in the percentage of body mass index(BMI)<25 kg/m^(2),American Society of Anesthesiologists(ASA)gradeⅢ-Ⅳand Karnofsky Performance Status Scale(KPS)score<80 before surgery,brain tumor diameter>4 cm,WHO pathological gradeⅢ-Ⅳand operation duration>4 h,as well as decreases in the dosage of sufentanil,compared with the control group(P<0.05).Multivariate Logistic regression showed that BMI<25 kg/m^(2)[odds ratio(OR)=0.451,95%CI 0.238-0.854,P=0.015],KPS<80 before surgery(OR=3.449,95%CI 1.282-9.279,P=0.014),WHO gradeⅢ-Ⅳ(OR=3.499,95%CI 1.744-7.018,P<0.001)and operative duration>4 h(OR=4.623,95%CI 2.425-8.816,P<0.001)were the risk factors for delayed emergence from general anesthesia after brain tumor resection(P<0.05).Conclusions Delayed emergence after neurosurgery is not rare,and BMI<25 kg/m^(2),KPS score<80 before surgery,WHO gradeⅢ-Ⅳand operation duration>4 h are the risk factors of delayed emergence after resection of brain tumor.