1200例全麻患者术后躁动原因分析及防治

目的分析1 200例气管内全麻患者术后躁动发生的原因,提出合适的防治策略。方法观察1 200例气管内全麻患者术后躁动的发生率及躁动程度(按0～3级评估);各种不良刺激所致术后躁动的发生率及程度;不同手术类别、麻醉方法、性别、性格、血型发生术后躁动的比例;拮抗催醒、术后镇痛及拔管时机与术后躁动的关系。结果 258例患者发生不同程度的术后躁动,发生率为21.50%。各种不良刺激所致术后躁动的发生比例中疼痛占53.49%、气管导管刺激占30.23%、尿管刺激占8.91%、心理应激占3.48%、其他因素占3.88%。术后躁动发生率以胸外科手术病人最高,静吸复合全麻高于全凭静脉麻醉,男性明显多于女性,外向型性格者多于内向型性格者,A型血型者明显多于其他血型者;术毕使用拮抗催醒药易发生术后躁动;术后镇痛和苏醒前拔管可明显降低术后躁动的发生率。结论疼痛刺激是导致术后躁动最主要的原因。选择正确的麻醉方式和合理的麻醉管理,避免拔管时不良的躁动刺激,并给予充分的术后镇痛,可明显减少或避免术后躁动的发生。

Cause analysis and control of postoperative restlessness in 1,200 cases of patients who underwent the general anesthesia

Aim To analyze reasons for postoperative restlessness in 1,200 cases of patients who underwent the endotracheal anesthesia,and to put forward appropriate control strategy.Methods The incidence and restless degree（press 0～3 grade evaluation）were observed.All kinds of bad stimulation caused by the incidence of postoperative restless and degrees;Different operative category,anesthetic methods,gender,character,blood type,the proportion of postoperative restless happened;Antagonist snooze,postoperative analgesia and extubated timing with the relationship of postoperative restless.Results 258 patients happen different degree of postoperative restless,with an incidence of 21.50%.All kinds of bad stimulation caused the occurrence of Postoperative restless,pain accounted for 53.49%,the endotracheal tube stimulation of 30.23%,urinary canal stimulation of 8.91%,the psychological stress of 3.48%,other factors of 3.88%.Postoperative patients with thoracic surgeries restless occurence rate is highest,static suction composite general anesthesia than all by intravenous anesthesia,more boys than girls,extroverted person more than introverted person,type A blood person more than those of other kinds of blood;the other than Intraoperative use Picasso antagonism snooze medicine easy happening postoperative restless,Postoperative analgesia before waking and extubated can obviously reduce the incidence of postoperative restless.Conclusion Postoperative pain caused stimulation is restless the main cause.Choose the correct anesthetic technique and reasonable anesthesia management,avoid extubated when bad moving restlessly stimulation and give full of postoperative analgesia,can obviously reduce or avoid the occurrence of postoperative restless.