全麻腹腔镜全子宫切除术患者麻醉苏醒期并发低氧血症相关因素及护理对策

Related factors and the nursing strategies of the hypoxemia during anesthesia recovery period of patients after laparoscopic total hysterectomy under general anesthesia

目的:探讨全麻腹腔镜全子宫切除术(LTH)患者麻醉苏醒期并发低氧血症(HXA)的有关因素并提出护理对策。方法:选取2022年3月-2024年1月本院全麻LTH患者280例临床资料进行回顾性分析,采用logistic回归分析LTH患者麻醉苏醒期并发HXA的影响因素。构建回归预测模型并判定模型拟合优度与预测效能。结果:全麻LTH患者麻醉苏醒期HXA发生率为27.1%(76/280)。单因素分析显示,HXA组与无HXA组年龄、体质指数(BMI)、ASA分级、丙泊酚用量、手术时间、麻醉后恢复室(PACU)停留时间比较,有差异(P<0.05)。二元logistic回归分析显示,年龄≥65岁(OR=1.926,95%CI 1.073~3.458)、BMI高(OR=1.824,95%CI 1.485~2.239)、ASA分级Ⅲ级(OR=2.353,95%CI 1.124~4.926)、丙泊酚用量大(OR=1.005,95%CI 1.002~1.008)、手术时间长(OR=1.078,95%CI 1.050~1.107)是全麻LTH患者麻醉苏醒期并发HXA的影响因素(P<0.05)。根据上述影响因素构建预测模型,H-L检验预测模型拟合优度良好,受试者操作特征(ROC)曲线可知,模型对全麻LTH患者麻醉苏醒期并发HXA的预测曲线下面积为0.900,敏感性为80.3%,特异性为87.3%。结论:年龄≥65岁、BMI高、ASA分级Ⅲ级、丙泊酚用量大、手术时间长均可影响全麻LTH患者麻醉苏醒期HXA的发生,且据此建立的预测模型预测效力良好,临床应据此予以针对性预防及护理,以降低麻醉苏醒期HXA发生风险。

Objective:To investigate the related factors of the hypoxemia during anesthesia recovery period of patients after laparoscopic total hysterectomy(LTH)under general anesthesia,and to provide the nursing countermeasures of the hypoxemia.Methods:The clinical data of 280 patients with LTH under general anesthesia in hospital from March 2022 to January 2024 were analyzed retrospectively.Logistic regression was used to analyze the influencing factors of the hypoxemia of the patients with LTH during the anesthesia recovery.The regression prediction model was constructed,and the goodness of fit and the predictive efficiency of the model for the hypoxemia of the patients with LTH during the anesthesia recovery was determined.Results:The incidence of the hypoxemia of the patients with LTH during anesthesia recovery was 27.1%(76/280).Univariate analysis showed that there were significant differences in the age,the body mass index(BMI),the classification by American society of anesthesiologists(ASA)rating,the dosage of propofol used,the operation time,and the duration of the post-anesthesia care unit(PACU)stay between the patients with hypoxemia and the patients without hypoxemia(P<0.05).Binary logistic regression analysis showed that the age≥65years old(OR=1.926,95%CI 1.073-3.458),the high BMI(OR=1.824,95%CI 1.485-2.239),the gradeⅢof ASA(OR=2.353,95%CI 1.073-3.458),the high dosage of propofol used(OR=1.005,95%CI 1.002-1.008)and the long operation time(OR=1.078,95%CI 1.050-1.107)of the patients with LTH were the factors influencing their hypoxemia during the anesthesia recovery period(P<0.05).According to these influencing factors,the prediction model was constructed,and the H-L test prediction model had a good goodness of fit.Receiver operating characteristic(ROC)curve showed that the area under the curve,the sensitivity and the specificity of the model for predicting the hypoxemia of the patients with LTH during the anesthesia recovery period were 0.900,80.3%and 87.3%,respectively.Conclusion:The age≥65years old,the high BMI,the grade Ⅲ of ASA,the high dosage of propofol used,and the long operation time of the patients with LTH during the anesthesia recovery period can affect their hypoxemia occurrence,and the prediction model established based on these affecting factors has the good predictive effect for the hypoxemia occurrence of the patients.The clinical prevention and nursing based on the prediction model should be conducted,so as to reduce the risk of the hypoxemia of the patients with LTH during the anesthesia recovery period.