本文選題：全身麻醉　切入點(diǎn)：肝腫瘤切除術(shù)　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過對我院全麻下肝腫瘤切除術(shù)患者術(shù)后是否存在蘇醒延遲的回顧性分析,探討術(shù)中不同用藥情況等相關(guān)因素對全麻下肝腫瘤切除術(shù)患者術(shù)后是否發(fā)生蘇醒延遲的影響,為患者術(shù)后的快速康復(fù)提供參考依據(jù)。方法:本文數(shù)據(jù)選取自2014年至2016年廣西醫(yī)科大學(xué)第一附屬醫(yī)院東院手術(shù)室全麻下行肝腫瘤切除術(shù)的患者的電子病歷、麻醉記錄單以及復(fù)蘇單。納入者年齡在18歲至65歲之間,排除條件:數(shù)據(jù)不完整(如缺失部分血流動力學(xué)參數(shù),術(shù)中未監(jiān)測本文所需的數(shù)據(jù)類型,病歷記錄不全等),最終共納入病例309例。運(yùn)用Logistic回歸分析對臨床病例資料進(jìn)行統(tǒng)計(jì)分析,探討全麻下肝腫瘤切除術(shù)患者術(shù)后發(fā)生蘇醒延遲的相關(guān)因素。結(jié)果:影響術(shù)后蘇醒延遲發(fā)生的監(jiān)測變量包括:患者的年齡、性別、體重、身高、肝功能分級、貧血、高血壓、糖尿病、飲酒史、吸煙史、肺部疾病史、全麻史、麻醉時(shí)間、ASA分級、手術(shù)級別、是否復(fù)合吸入麻醉、是否復(fù)合硬膜外麻醉、術(shù)中丙泊酚、瑞芬太尼及芬太尼用量、術(shù)中總輸液量、術(shù)中輸血情況、是否采用BIS監(jiān)測麻醉深度及術(shù)后即時(shí)體溫共計(jì)24項(xiàng)。對以上變量進(jìn)行單因素分析后,通過篩選(P0.05)選出具有統(tǒng)計(jì)學(xué)意義的變量行多因素Logistics回歸分析,結(jié)果顯示影響全麻下肝腫瘤切除術(shù)患者術(shù)后是否發(fā)生蘇醒延遲的因素有9個,其差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。按照OR值從大到小排序如下:丙泊酚用量(OR=4.073,P=0.023)、麻醉時(shí)長(OR=2.488,P=0.034)、年齡(OR=1.909,P=0.028)、術(shù)后即時(shí)體溫(OR=1.893,P0.001)、飲酒(OR=1.658,P=0.03)、吸煙(OR=1.378,P=0.017)、貧血(OR=1.251,P=0.002)、術(shù)中輸液總量(OR=1.177,P0.001)及BIS監(jiān)測(OR=0.298,P0.001)。結(jié)論:1、隨著肝腫瘤切除術(shù)患者的年齡、麻醉時(shí)長、術(shù)中輸液量以及術(shù)中丙泊酚用量的的增加,發(fā)生術(shù)后蘇醒延遲的風(fēng)險(xiǎn)增高。2、肝腫瘤切除術(shù)患者飲酒、吸煙、貧血、術(shù)中是否應(yīng)用BIS監(jiān)測以及術(shù)后低溫是影響術(shù)后是否發(fā)生蘇醒延遲的危險(xiǎn)因素。
[Abstract]:Objective: to analyze retrospectively whether there is a delayed recovery in patients with liver tumor resection under general anesthesia in our hospital, and to explore the influence of different drugs during operation on the postoperative recovery delay of patients undergoing hepatectomy under general anesthesia. Methods: from 2014 to 2016, we selected the electronic medical records of patients undergoing hepatectomy under general anesthesia in the Eastern Hospital of the first affiliated Hospital of Guangxi Medical University. Anaesthesia record sheet and resuscitation sheet. The participants were between 18 and 65 years of age, exclusion conditions: incomplete data (such as missing partial hemodynamic parameters, lack of intraoperative monitoring of the data types required for this article), Incomplete medical records were recorded and 309 cases were included. The clinical data were statistically analyzed by Logistic regression analysis. Objective: to investigate the related factors of postoperative recovery delay in patients with liver tumor resection under general anesthesia. Results: age, sex, weight, height, grade of liver function, anemia, hypertension were the monitoring variables that affected the delayed recovery after operation, and the related factors were: age, sex, weight, height, grade of liver function, anemia, hypertension. Diabetes mellitus, history of alcohol consumption, history of smoking, history of lung disease, history of general anesthesia, time of anesthesia, ASA classification, surgical grade, compound inhalation anesthesia, combined epidural anesthesia, intraoperative propofol, remifentanil and fentanyl dosage, The total volume of infusion during operation, the blood transfusion during operation, whether the anesthetic depth and body temperature were monitored by BIS were 24 items. The multivariate Logistics regression analysis showed that there were 9 factors influencing the delayed recovery after hepatectomy under general anesthesia. The difference was statistically significant (P 0.05). According to OR value, the order was as follows: the dosage of propofol was 4.073P0. 023, the duration of anaesthesia was 2.488P0.034, the age was 1.909 P0. 028, the body temperature was OR1. 893P0. 001, the body temperature was OR1. 893P0. 001, drinking alcohol was 1. 658P0.03, smoking OR1.378P0. 017, anemic OR1.251P0. 002, the total volume of intraoperative infusion: OR1. 177p 0. 001and BIS monitoring OR1. 298P0. 001. conclusion: 1. Age of patients undergoing hepatectomy, The duration of anesthesia, the volume of intraoperative infusion and the dosage of propofol during operation, the risk of delayed recovery after operation were increased. Intraoperative BIS monitoring and postoperative hypothermia were risk factors for delayed recovery.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614;R735.7

【參考文獻(xiàn)】

相關(guān)期刊論文 前8條

1 杜小兵;;七氟醚靜吸復(fù)合麻醉對肝葉切除術(shù)患者肝腎功能的影響[J];安徽醫(yī)藥;2016年02期

2 李薇;胡恒;鄭茂;;23例全身麻醉蘇醒延遲臨床分析[J];四川醫(yī)學(xué);2011年09期

3 郭新乾;楊志強(qiáng);;全身麻醉蘇醒延遲4例報(bào)告[J];吉林醫(yī)學(xué);2011年17期

4 鄧超;代志剛;張紅;;腦電雙頻指數(shù)監(jiān)測技術(shù)及其臨床應(yīng)用[J];現(xiàn)代生物醫(yī)學(xué)進(jìn)展;2011年02期

5 李艷麗;何楊;鄭艷;;全麻后蘇醒延遲的原因分析及處理體會[J];中國醫(yī)學(xué)創(chuàng)新;2010年21期

6 張愛蓮;;BIS監(jiān)測在重大腫瘤手術(shù)麻醉中的應(yīng)用[J];現(xiàn)代腫瘤醫(yī)學(xué);2009年11期

7 劉白莎;全麻蘇醒延遲12例分析[J];中國誤診學(xué)雜志;2003年09期

8 姚明,常向陽,方芬;全身麻醉蘇醒延遲8例的教訓(xùn)與處理[J];臨床麻醉學(xué)雜志;1998年03期

，

本文編號：1695627