腹腔镜下全子宫切除术麻醉恢复期躁动的危险因素预测模型

周敏; 严康明; 周群英; 李晓明

doi:10.11659/jjssx.08E022162

您当前的位置：

首页 >

文章列表页 >

腹腔镜下全子宫切除术麻醉恢复期躁动的危险因素预测模型

临床研究 | 更新时间：2023-05-26

- 腹腔镜下全子宫切除术麻醉恢复期躁动的危险因素预测模型
- Predictive model of risk factors for restlessness during anesthesia recovery period in laparoscopic hysterectomy
- 局解手术学杂志 2023年32卷第5期页码：439-443
- 作者机构：
  
  1.皖西卫生职业学院附属医院麻醉科,安徽六安 237000
  2.皖西卫生职业学院附属医院妇产科,安徽六安 237000
- 作者简介：
  
  李晓明，E-mail：15055233399@163.com
- 基金信息：
  
  2021年度安徽高校自然科学研究项目(KJ2021A1368);2020年度安徽高校自然科学研究项目(KJ2020A0956)
- DOI：10.11659/jjssx.08E022162
  中图分类号： R713.4+2
- 纸质出版日期：2023-05-25，
  
  收稿日期：2022-08-30，
扫描看全文
周敏,严康明,周群英等.腹腔镜下全子宫切除术麻醉恢复期躁动的危险因素预测模型[J].局解手术学杂志,2023,32(05):439-443.

ZHOU Min,YAN Kang-ming,ZHOU Qun-ying,et al.Predictive model of risk factors for restlessness during anesthesia recovery period in laparoscopic hysterectomy[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(05):439-443.
周敏,严康明,周群英等.腹腔镜下全子宫切除术麻醉恢复期躁动的危险因素预测模型[J].局解手术学杂志,2023,32(05):439-443. DOI： 10.11659/jjssx.08E022162.

ZHOU Min,YAN Kang-ming,ZHOU Qun-ying,et al.Predictive model of risk factors for restlessness during anesthesia recovery period in laparoscopic hysterectomy[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(05):439-443. DOI： 10.11659/jjssx.08E022162.

摘要

目的

研究腹腔镜下全子宫切除术患者麻醉恢复期躁动的危险因素并构建预测模型。

方法

选取在我院进行腹腔镜下全子宫切除术的200例患者为研究对象，根据Riker躁动、镇静评分标准，将≤4级的152例患者纳入无躁动组，将≥5级的48例患者纳入躁动组。对比2组患者的临床资料，分析影响腹腔镜下全子宫切除术患者麻醉恢复期躁动的相关因素；采用受试者工作特征（

ROC

）曲线分析相关因素对腹腔镜下全子宫切除术患者麻醉恢复期躁动的预测价值；

Logistic

多元回归模型分析影响腹腔镜下全子宫切除术患者麻醉恢复期躁动的独立危险因素；R语言软件4.0“rms”包构建预测腹腔镜下全子宫切除术患者麻醉恢复期躁动的列线图模型。

结果

与无躁动组相比，躁动组患者年龄较大，ASA分级Ⅲ级比例、术后留置导尿管比例、低氧血症比例、肌松药残留比例较高，采取术后镇痛比例较低，手术时间及麻醉时间较长

差异有统计学意义（

0.05）。年龄、手术时间、麻醉时间的

AUC

分别为0.719、0.597、0.610，最佳截断值分别为55岁、83 min、93 min。年龄

55岁、ASA分级Ⅲ级、术后未镇痛、术后留置导尿管、低氧血症、肌松药残留是腹腔镜下全子宫切除术患者麻醉恢复期躁动的独立危险因素。列线图模型预测腹腔镜下全子宫切除术患者麻醉恢复期躁动的

C-index

为0.796（95%

：0.613～0.867），阈值

0.19，列线图模型提供临床净收益率均高于独立预测因子。

结论

本研究基于年龄、ASA分级、术后镇痛、留置导尿管、低氧血症、肌松药残留构建了预测腹腔镜下全子宫切除术患者麻醉恢复期躁动的列线图模型，可用于麻醉恢复期躁动的早期预测及探查，防止躁动对患者造成损伤，确保安全。

Abstract

Objective

To study the risk factors of restlessness during anesthesia recovery period in patients undergoing laparoscopic hysterectomy and to construct a predictive model.

Methods

A total of 200 patients who underwent laparoscopic hysterectomy in our hospital were selected as the research subjects.According to the Riker restlessness and sedation scoring criteria，152 patients with grade ≤4 were included in the non-restlessness group，and 48 patients with grade ≥5 were included in the restlessness group.The clinical data of the two groups were compared，and the related factors affecting the restlessness during anesthesia recovery period in patients underwent laparoscopic hysterectomy were analyzed.The

receiver operating characteristic

（

ROC

） curve was used to analyze the predictive value of related factors for restlessness during anesthesia recovery period in patients underwent laparoscopic hysterectomy.

Logistic

multiple regression model was used to analyze the independent risk factors for restlessness during anesthesia recovery period in patients undergoing laparoscopic hysterectomy.R language software 4.0 "rms" package was used to construct an nomogram model for predicting the restlessness during anesthesia recovery period in patients undergoing laparoscopic hysterectomy.

Results

Compared with the non-restlessness group，the patients in the restlessness group were older，with higher proportions of ASA grade Ⅲ，postoperative indwelling catheter，hypoxemia，muscle relaxant residue，lower proportion of postoperative analgesia，and longer operation time and anesthesia time（

0.05）.The

AUC

of age，operation time and anesthesia time were 0.719，0.597 and 0.610，respectively，and the best cut-off values were 55 years old，83 minutes and 93 minutes，respectively.Age

55 years old，ASA gradeⅢ，lack of postoperative analgesia，indwelling catheter after operation，hypoxemia and muscle relaxant residue were the independent risk factors for restlessness during anesthesia recovery period in patients underwent laparoscopic hysterectomy.The

index

of nomogram model for predicting the restlessness during anesthesia recovery period was 0.796（95%

：0.613 to 0.867） in patients underwent laparoscopic hysterectomy，and the threshold value was

0.19.The clinical net income provided by the nomogram model was higher than those provided by the independent predictors.

Conclusion

Based on age，ASA grade，postoperative analgesia，indwelling catheter，hypoxemia，and muscle relaxant residue，this study construct an nomogram model for predicting restlessness during anesthesia recovery period in patients undergoing laparoscopic hysterectomy，which can be used for the early prediction and exploration of restlessness during anesthesia recovery period，to prevent damage caused by restlessness to patients，and to ensure safety.

关键词

腹腔镜下全子宫切除术麻醉恢复期躁动危险因素列线图预测模型

Keywords

laparoscopic hysterectomyanesthesia recovery periodrestlessnessrisk factorsnomogram prediction model

references

于丽丽，张秀冰，陈超，等.腹腔镜全子宫切除术与腹腔镜次全子宫切除术对子宫多发肌瘤患者卵巢功能影响研究［J］.临床军医杂志，2021，49（6）：707-708.doi：10.16680/j.1671-3826.2021.06.38http://dx.doi.org/10.16680/j.1671-3826.2021.06.38.

Sandberg EM，Twijnstra ARH，Driessen SRC，et al.Total laparoscopic hysterectomy versus vaginal hysterectomy：a systematic review and meta-analysis［J］.J Minim Invasive Gynecol，2017，24（2）：206-217.doi：10.1016/j.jmig.2016.10.020http://dx.doi.org/10.1016/j.jmig.2016.10.020.

陈义波，郭海春，朱辉玲，等.常规器械经脐单孔三通道法腹腔镜与传统腹腔镜下全子宫切除术的对比研究［J］.湖南师范大学学报（医学版），2021，18（2）：123-126.doi：10.3969/j.issn.1673-016X.2021.02.035http://dx.doi.org/10.3969/j.issn.1673-016X.2021.02.035.

胡松权，宋劼，周群.超声引导腹横肌平面阻滞联合腹直肌鞘阻滞在腹腔镜全子宫切除术患者中的应激状况及术后镇痛效果［J］.中国妇幼保健，2022，37（6）：1140-1143.doi：10.19829/j.zgfybj.issn.1001-4411.2022.06.049http://dx.doi.org/10.19829/j.zgfybj.issn.1001-4411.2022.06.049.

邓国平，黄桂琴，牛金波.羟考酮对腹腔镜子宫肌瘤剔除术患者七氟烷麻醉苏醒期躁动影响研究［J］.中国妇幼保健，2021，36（16）：3855-3858.doi：10.19829/j.zgfybj.issn.1001-4411.2021.16.062http://dx.doi.org/10.19829/j.zgfybj.issn.1001-4411.2021.16.062.

皮勇，黄桂华，高伟忠，等.老年全麻下全髋关节置换患者术后麻醉恢复期躁动发生影响因素［J］.中国老年学杂志，2022，42（17）：4186-4189.doi：10.3969/j.issn.1005-9202.2022.17.016http://dx.doi.org/10.3969/j.issn.1005-9202.2022.17.016.

任洪侠.研究丙泊酚对腹腔镜下子宫肌瘤剔除术患者全身麻醉苏醒期躁动的影响［J］.中国医疗器械信息，2018，24（10）：50-51.doi：10.15971/j.cnki.cmdi.2018.10.025http://dx.doi.org/10.15971/j.cnki.cmdi.2018.10.025.

Balachandran VP，Gonen M，Smith JJ，et al.Nomograms in oncology：more than meets the eye［J］.Lancet Oncol，2015，16（4）：e173-e180.doi：10.1016/S1470-2045（14）71116-7http://dx.doi.org/10.1016/S1470-2045（14）71116-7.

Lepousé C，Lautner CA，Liu L，et al.Emergence delirium in adults in the post-anaesthesia care unit［J］.Br J Anaesth，2006，96（6）：747-753.doi：10.1093/bja/ael094http://dx.doi.org/10.1093/bja/ael094.

Macciò A，Chiappe G，Lavra F，et al.Laparoscopic hysterectomy as optimal approach for 5400 grams uterus with associated polycythemia：a case report［J］.World J Clin Cases，2019，7（19）：3027-3032.doi：10.12998/wjcc.v7.i19.3027http://dx.doi.org/10.12998/wjcc.v7.i19.3027.

Veit-Rubin N，Dubuisson JB，Lange S，et al.Uterus-preserving laparoscopic lateral suspension with mesh for pelvic organ prolapse：a patient-centred outcome report and video of a continuous series of 245 patients［J］.Int Urogynecol J，2016，27（3）：491-493.doi：10.1007/s00192-015-2859-6http://dx.doi.org/10.1007/s00192-015-2859-6.

Koceroglu I，Devrim S，Tanriverdi TB，et al.The effects of dexmedetomidine and tramadol on post‐operative pain and agitation，and extubation quality in paediatric patients undergoing adenotonsillectomy surgery：a randomized trial［J］.J Clin Pharm Ther，2020，45（2）：340-346.doi：10.1111/jcpt.13080http://dx.doi.org/10.1111/jcpt.13080.

蔡旭柔，洪奕珊，黄志良，等.心理干预对腹腔镜手术患者麻醉恢复期的影响［J］.中华全科医学，2013，11（5）：754.

童珊珊，李军，彭春玲，等.麻醉恢复室的成年患者全麻苏醒期躁动危险因素分析［J］.重庆医学，2015，44（10）：1340-1342.doi：10.3969/j.issn.1671-8348.2015.10.015http://dx.doi.org/10.3969/j.issn.1671-8348.2015.10.015.

杨荣宽.老年全麻手术苏醒期患者躁动发生状况及其危险因素［J］.实用临床医药杂志，2016，20（1）：163-165.doi：10.7619/jcmp.201601061http://dx.doi.org/10.7619/jcmp.201601061.

郑热容.气管插管全麻术后复苏期患者躁动的相关因素分析［J］.中国医药指南，2012，10（30）：97-98.

李玉洁，陈燕勤，金素琴，等.小儿全身麻醉苏醒期躁动的相关因素分析［J］.中国妇幼保健，2020，35（11）：2040-2043.doi：10.19829/j.zgfybj.issn.1001-4411.2020.11.027http://dx.doi.org/10.19829/j.zgfybj.issn.1001-4411.2020.11.027.

楚冬冬.手术室麻醉苏醒护理对腹部手术病人全麻苏醒期躁动的影响探究［J］.中医临床研究，2016，8（14）：113-114.doi：10.3969/j.issn.1674-7860.2016.14.060http://dx.doi.org/10.3969/j.issn.1674-7860.2016.14.060.

胡连莲，沙莎.妊娠合并高血压患者全麻剖宫产术后麻醉复苏期躁动的影响因素分析［J］.中国妇幼保健，2021，36（14）：3311-3314.doi：10.19829/j.zgfybj.issn.1001-4411.2021.14.047http://dx.doi.org/10.19829/j.zgfybj.issn.1001-4411.2021.14.047.

谭永坚，林健文，何晓铭.骨科全麻术后患者麻醉苏醒期躁动的影响因素分析［J］.中国卫生标准管理，2020，11（21）：60-62.doi：10.3969/j.issn.1674-9316.2020.21.022http://dx.doi.org/10.3969/j.issn.1674-9316.2020.21.022.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

病房全程管理的内外科嵌合模式下新生儿术后不良事件的危险因素分析

乳腺癌改良根治术中发生低体温风险列线图预测模型的构建

老年全膝关节置换术后股骨假体周围骨折的危险因素及预测模型

影响下腔静脉滤器回收的相关因素研究现状

老年患者行股骨转子间骨折内固定术后并发谵妄的相关因素分析