老年患者全麻后麻醉恢复室发生低氧血症的危险因素

Risk factors for hypoxemia in elderly patients after general anesthesia in postanesthesia care unit

目的探讨老年患者全麻后麻醉恢复室(PACU)内发生低氧血症的危险因素。方法选择2021年7月至2022年1月入PACU的全麻老年患者262例,男110例,女152例,年龄≥65岁,ASAⅠ—Ⅲ级。低氧血症定义为拔除气管导管或喉罩后30 min时的氧合指数≤300,根据PACU内是否发生低氧血症分为两组:低氧血症组和非低氧血症组。将单因素分析后P<0.1的指标纳入多因素Logistic回归分析,筛选老年患者全麻后PACU内发生低氧血症的危险因素。结果有105例(40.1%)患者PACU内发生低氧血症。单因素分析显示,与非低氧血症组比较,低氧血症组年龄明显增大,手术时间明显延长,术中输液量和出血量明显增多,ASAⅢ级、合并高血压、术前SpO_(2)<95%、术前压疮风险评分11~17分、术前Caprini血栓风险评分≥5分、俯卧位、术中输血、术后入PACU体温<36℃的比例明显升高(P<0.1)。多因素Logistic回归分析显示,合并高血压(OR=3.475,95%CI 1.781~6.781,P<0.001)、术前SpO_(2)<95%(OR=4.159,95%CI 1.768~9.782,P=0.001)、术前Caprini血栓风险评分≥5分(OR=4.582,95%CI 2.310~9.087,P=0.001)、入PACU体温<36.0℃(OR=6.023,95%CI 2.039~17.795,P=0.001)是老年患者全麻后PACU内发生低氧血症的独立危险因素。结论合并高血压、术前SpO_(2)<95%、术前Caprini血栓风险评分≥5分、入PACU体温<36.0℃是老年患者全麻后PACU内发生低氧血症的独立危险因素。

Objective To investigate and analyze the risk factors of hypoxemia in postanesthesia care unit(PACU)after general anesthesia in elderly patients.Methods A total of 262 elderly patients admitted to PACU after general anesthesia from July 2021 to January 2022 were selected as the research subjects,including 110 males and 152 females,aged≥65 years,ASA physical statusⅠtoⅢ.Hypoxemia was defined as the oxygenation index≤300 at 30 minutes after removal of the tracheal catheter or laryngeal mask.According to whether patients occurred hypoxemia in PACU,patients were divided into two groups:the hypoxemia group and the non-hypoxemia group.After univariate analysis,independent variables with P<0.1 were included in Logistic regression analysis to screen the risk factors of hypoxemia in PACU after general anesthesia in elderly patients.Results There were 105 patients(40.1%)with postoperative hypoxemia.Univariate analysis showed that the age of postoperative hypoxemia group was significantly increased,the operation time was significantly increased,and the amount of intraoperative fluid and blood loss increased,the proportion of ASA physical statusⅢ,combined hypertension,preoperative SpO_(2)<95%,preoperative Caprini thrombus risk score 11-17,preoperative caprini thrombosis risk score≥5,prone position,intraoperative blood transfusion,and postoperative PACU body temperature<36℃increased significantly(P<0.1).Logistic regression analysis showed that patients with hypertension(OR=3.475,95%CI 1.781-6.781,P<0.001),preoperative SpO_(2)<95%(OR=4.159,95%CI 1.768-9.782,P=0.001),preoperative Caprini thrombus risk score≥5(OR=4.582,95%CI 2.310-9.087,P=0.001),body temperature entering PACU<36.0℃(OR=6.023,95%CI 2.039-17.795,P=0.001)were independent risk factors for hypoxemia after general anesthesia in elderly patients.Conclusion Concomitant hypertension,preoperative SpO_(2)<95%,preoperative Caprini thrombosis risk score≥5,body temperature in PACU<36.0℃are independent risk factors for hypoxemia in PACU after general anesthesia in elderly patients.