全身麻醉对乳腺癌根治术患者麻醉苏醒延迟的高危影响因素分析

Analysis of high risk factors affecting delayed recovery of patients undergoing radical mastectomy under general anesthesia

目的探讨全身麻醉下影响乳腺癌根治术患者苏醒延迟的高危因素。方法选择2020年7月至2022年8月在首都医科大学附属北京同仁医院行乳腺癌根治术治疗的患者作为研究对象,筛选后共获得80例患者的有效数据。将患者分为非苏醒延迟组(54例)与苏醒延迟组(26例),比较两组患者一般情况与围手术期资料,应用Logistic风险比例回归模型分析影响患者麻醉苏醒延迟的高危因素。结果非苏醒延迟组与苏醒延迟组患者的体质量指数、高血压、糖尿病、肿瘤大小、肿瘤亚型、肿瘤部位、肿瘤分期差异无统计学意义(均P>0.05)。苏醒延迟组患者平均年龄(53.28±11.01)、贫血占比为42.30%(11/26)、ASAⅡ级患者占比为76.92%(20/26),较非苏醒延迟组平均年龄(46.89±6.91)(t=3.17,P=0.002)、贫血占比20.37%(11/54)(χ^(2)=3.17,P=0.040)、ASAⅡ级患者占比27.78%(15/54)(χ^(2)=17.22,P<0.001)显著增加。在围手术期资料中,非苏醒延迟组与苏醒延迟组患者术中复合硬膜外麻醉情况差异无统计学意义(均P>0.05)。苏醒延迟组患者平均术中出血量(234.14±32.28)、手术时间(229.47±29.84)、麻醉时间(246.14±35.64)、术中复合七氟烷吸入占比69.23%(18/26),较非苏醒延迟组患者平均术中出血量(215.48±29.54)(t=2.57,P=0.012)、手术时间(206.35±27.41)(t=3.43,P=0.001)、麻醉时间(215.61±28.54)(t=4.13,P<0.001)、术中复合七氟烷吸入占比44.44%(24/54)显著增加。通过Logistic风险比例回归分析发现年龄(OR=1.15,95%CI:1.05~1.30,P=0.008)、ASAⅡ级(OR=9.49,95%CI:2.05~60.94,P=0.008)、术中出血量(OR=1.04,95%CI:1.01~1.08,P=0.012)、手术时间(OR=1.05,95%CI:1.01~1.08,P=0.009)、麻醉时间(OR=1.04,95%CI:1.02~1.07,P=0.004)是影响患者麻醉苏醒延迟的高危因素。结论年龄增加、ASA高级别、术中出血量大、手术时间与麻醉时间长是影响患者麻醉苏醒延迟的独立危险因素。

Objective To investigate the risk factors affecting the delay of recovery in patients under general anesthesia.Methods Patients who underwent radical mastectomy for breast cancer in our hospital from Jul.2020 to Aug.2022 were selected as the research objects,and the effective data of 80 patients were obtained after screening.The patients were divided into the non-delayed recovery group(54 cases)and the delayed recovery group(26 cases).The general conditions and perioperative data of the two groups were compared,and the high-risk factors affecting delayed recovery from anesthesia were analyzed using the Logistic hazard proportional regression model.Results In general,there were no significant differences in body mass index,hypertension,diabetes,tumor size,tumor subtype,tumor location,or tumor stage between the non-delayed awakening group and the delayed awakening group(all P>0.05).The average age of patients in the wake-up delay group was(53.28±11.01),the proportion of anemia was 42.30%(11/26),and the proportion of ASAⅡpatients was 76.92%(20/26)compared with the average age of the non-wake-up delay group(46.89±6.91)(t=3.17,P=0.002),the proportion of anemia was 20.37%(11/54)(χ^(2)=3.17,P=0.040),the proportion of ASAⅡpatients was 27.78%(15/54)(χ^(2)=17.22,P<0.001),which was significantly increased.In the perioperative data,there was no statistical significance in the intraoperative combined epidural anesthesia between the non-delayed recovery group and the delayed recovery group(all P>0.05).The data of the patients in the delayed recovery group,including average intraoperative blood loss(234.14±32.28),operation time(229.47±29.84),anesthesia time(246.14±35.64)and intraoperative compound sevoflurane inhalation accounted for 69.23%(18/26),which were significantly increased compared with the data of non-delayed recovery group following,including the average intraoperative blood loss(215.48±29.54)(t=2.57,P=0.012),operation time(206.35±27.41)(t=3.43,P=0.001),anesthesia time(215.61±28.54)(t=4.13,P<0.001),intraoperative compound sevoflurane inhalation(44.44%,24/54).Through Logistic hazard ratio regression analysis,it was found that age(OR=1.15,95%CI:1.05-1.30,P=0.008),ASAⅡgrade(OR=9.49,95%CI:2.05-60.94,P=0.008),intraoperative bleeding volume(OR=1.04,95%CI:1.01-1.08,P=0.012),operation time(OR=1.05,95%CI:1.01-1.08,P=0.009),and anesthesia time(OR=1.04,95%CI:1.02-1.07,P=0.004)were high-risk factors affecting the delayed recovery from anesthesia.Conclusion Increasing age,high grade of ASA,heavy intraoperative blood loss,long operation time and anesthesia time are independent risk factors affecting delayed recovery from anesthesia.