胸腹腔镜联合食管癌根治术患者全麻苏醒延迟的影响因素分析

Analysis of influencing factors on delayed emergence from general anesthesia in patients undergoing combined thoracoscopic and laparoscopic radical resection of esophageal cancer

目的分析胸腹腔镜联合食管癌根治术全身麻醉后患者发生苏醒延迟的影响因素。方法选取行胸腹腔镜联合食管癌根治术患者作为研究对象,回顾性分析2019年7月至2021年7月四川大学华西医院收治的298例行胸腹腔镜联合食管癌根治术患者的临床资料,根据麻醉苏醒期是否发生苏醒延迟将患者分为苏醒延迟组(33例)和非苏醒延迟组(265例),比较两组患者一般资料和围术期资料的差异,采用多因素Logistic回归方程分析其发生苏醒延迟的影响因素。结果食管癌根治术患者苏醒延迟发生率为12.5%,单因素分析结果显示:苏醒延迟组和非苏醒延迟组比较,两组患者年龄≥65岁、术前合并呼吸功能障碍、术中低体温(T<36℃)、麻醉时长≥6 h、术中输液量≥2000 mL、术中舒芬太尼≥50μg差异有统计学意义(P<0.05)。苏醒延迟组和非苏醒延迟组比较,两组患者性别、ASA分级Ⅲ级、术前放化疗、合并高血压、合并糖尿病、术中丙泊酚用量、术后血液二氧化碳浓度、术中麻醉维持方式、术中尿量、术中出血量、术中瑞芬太尼用量差异无统计学意义(P>0.05)。多因素分析结果示:苏醒延迟的独立危险因素有年龄≥65岁、术前合并呼吸功能障碍、术中低体温(T<36℃)、术中输液量≥2000 mL及麻醉时长≥6 h(P<0.05)。结论麻醉时长≥6 h、术中输液量≥2000 mL、年龄≥65岁、术前合并呼吸功能障碍、术中低体温(T<36℃)会增加全麻下胸腹腔镜联合食管癌根治术患者苏醒延迟发生的风险,医护人员应在围术期准确评估此类患者情况,及时针对性处理,减少或避免苏醒延迟的发生。

Objective To analyze the influencing factors of delayed emergence after general anesthesia in patients undergoing combined thoracoscopic and laparoscopic radical resection of esophageal cancer.Methods Patients undergoing combined thoracoscopic and laparoscopic radical resection of esophageal cancer were selected as the research objects,the clinical data of 298 patients with esophageal cancer who underwent combined thoracoscopic and laparoscopic radical resection in West China Hospital of Sichuan University from July 2020 to July 2022 were retrospectively analyzed.Patients were divided into delayed emergence group(33 cases)and non-delayed emergence group(265 cases)according to whether there was delayed emergence after anesthesia.The differences in general data and perioperative data between the two groups were compared,Multivariate logistic regression equation was used to analyze the influencing factors of delayed emergence.Results In patients with laparoscopic combined thoracic esophageal cancer radical resection,the delayed emergence was at a rate of 12.5%.Univariate analysis showed that:The delayed awakening group was compared with the non-delayed awakening group,there were significant differences in age≥65 years,preoperative respiratory dysfunction,intraoperative hypothermia(T<36℃),anesthesia duration≥6 h,and intraoperative infusion volume≥2000 ml between the two groups(P<0.05).The delayed awakening group was compared with the non-delayed awakening group,there were no significant differences in gender,ASA physical statusⅢ,preoperative chemoradiotherapy,hypertension,diabetes mellitus,intraoperative propofol dosage≥1000 mg,blood carbon dioxide concentration,and intraoperative anesthesia maintenance mode between the two groups(P>0.05).Multivariate analysis showed that:The independent risk factors for delayed recovery were age≥65 years,preoperative respiratory dysfunction,intraoperative hypothermia(T<36℃),intraoperative infusion volume≥2000 ml and anesthesia duration≥6 h(P<0.05).Conclusion Duration of anesthesia≥6 h,intraoperative infusion volume≥2000 ml,age≥65 years old,preoperative respiratory dysfunction,intraoperative hypothermia(T<36℃)will increase the risk of delayed recovery of patients undergoing combined thoracoscopic and laparoscopic radical resection of esophageal cancer under general anesthesia.