全麻苏醒期患者躁动的危险因素分析

目的探讨全身麻醉患者麻醉苏醒期躁动的危险因素。方法选择全身麻醉患者240例,使用镇静躁动分级法对患者术后30 min的苏醒状况进行评分,保留4分及以上的患者（200例）,对其相关病史资料作Logistic回归分析,探讨苏醒期躁动的危险因素。结果经单因素分析：不同术前用药、是否给予咪达唑仑、气道管理方式、麻醉维持药物、有创操作与麻醉诱导次序、术时长短及术毕是否使用麻醉气体吸附器与躁动的发生显著相关（P值分别为：0.022、0.034、0.004、0.000、0.008、0.015、0.028）。经多因素分析：诱导使用咪达唑仑、术毕给予新斯的明、麻醉前留置胃管、麻醉前留置导尿管、全凭吸入麻醉等与躁动发生显著相关（P值分别为：0.026、0.007、0.004、0.042、0.0001,OR值分别为：2.603、0.317、2.264、0.334、9.173）。结论全身麻醉患者麻醉诱导前留置胃管、麻醉诱导期经静脉给予咪达唑仑、吸入七氟醚维持麻醉,术后躁动发生率显著增高,而术毕使用肌松药拮抗剂新斯的明、术前留置导尿管可以减少术后躁动的发生。

Risk factors for emergence agitation during recovery period in general anesthesia

Objective To investigate the risk factors for emergence agitation during the recovery period in general anesthesia. Methods Two hundred forty patients following general anesthesia were enrolled and the level of emergence agitation was scored by sedation-agitation scale（ SAS）30 m in after surgery. Patients with SA S less than 4 were excluded. Related medical records of the rest 200 cases were subjected to univariate and multivariate Logistic regression for analysis risk factors of emergence agitation. Results Univariate analysis revealed that premedication,midazolam,airway management,anesthesia maintenance,interventional manipulation,operation time and the usage of anesthetic gas absorber were significantly related with the incidence of agitation（ P = 0. 022,0. 034,0. 004,0. 000 1,0. 008,0. 015 and 0. 028,respectively）.Multivariate analysis revealed that midazolam,neostigmine,intragastric tube,urinary catheterization after anesthesia and total inhalational anesthesia were significantly related with the incidence of agitation（ O R = 2. 603,0. 317,2. 264,0. 334 and 9. 173; P = 0. 026,0. 007,0. 004,0. 042 and 0. 000 1,respectively）. Conclusion Induction with midazolam,gastric intubation before anesthesia and total inhalational anesthesia are risk factors for emergence agitation following general anesthesia, while giving neostigmine after operation and urinary catheterization before anesthesia may reduce the incidence.