腹腔镜下子宫切除术患者麻醉苏醒期谵妄发生现状及其相关因素分析

李佳; 赵墨菊; 杨惠茹; 高丽峰; 高月; 李侃; 郭素娜; 沈建军

doi:10.16766/j.cnki.issn.1674-4152.004294

腹腔镜下子宫切除术患者麻醉苏醒期谵妄发生现状及其相关因素分析

doi: 10.16766/j.cnki.issn.1674-4152.004294

1.
张家口市第一医院麻醉科，河北张家口 075000
2.
张家口市第一医院透析室
3.
张家口市第一医院麻醉科
4.
张家口市第一医院妇科

基金项目:

河北省2024年度医学科学研究课题计划 20241628

详细信息

通讯作者:
李佳，E-mail：284870400@qq.com

中图分类号: R713.42 R614.27
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- 文章访问数: 12
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出版历程
- 收稿日期: 2025-06-11
- 网络出版日期: 2026-03-13

The occurrence and related factors of delirium in patients undergoing laparoscopic hysterectomy during the anesthesia recovery period

1.
Department of Anesthesiology, Zhangjiakou First Hospital, Zhangjiakou, Hebei 075000, China

摘要

摘要: 目的分析腹腔镜下子宫切除术患者麻醉苏醒期谵妄发生现状，探讨其影响因素，为临床预防和干预提供依据，提高术后康复质量。方法选取2021年1月—2024年1月于张家口市第一医院择期行腹腔镜下子宫切除术的120例女性患者，收集患者围手术期相关数据，根据术后麻醉苏醒期是否发生谵妄分为谵妄组和非谵妄组。观察腹腔镜下子宫切除术患者麻醉苏醒期谵妄发生率。采用单因素和多因素logistic回归分析腹腔镜下子宫切除术患者麻醉苏醒期谵妄发生的独立危险因素。结果子宫切除术患者谵妄发生率为13.34%(16/120)；单因素和多因素logistic回归分析结果显示，睡眠障碍、术前/中使用右美托咪定、CO₂气腹时间、手术时间、术中出血量、VAS评分及麻醉药物总量均是影响患者发生谵妄的因素(P分别为0.006、0.033、0.004、0.002、0.010、0.024及0.005，OR 95% CI分别为1.501~11.659、1.074~5.191、1.287~3.826、1.250~2.705、1.310~7.211、1.109~4.189及1.349~5.360)。结论睡眠障碍、术前/中使用右美托咪定、CO₂气腹时间、手术时间、术中出血量、VAS评分及麻醉药物总量均是腹腔镜下子宫切除术患者麻醉苏醒期谵妄发生的影响因素，临床应针对以上影响因素积极预防干预。
- 子宫切除术 /
- 麻醉苏醒期 /
- 谵妄 /
- 危险因素
Abstract: Objective To analyze the current status of delirium during anesthesia recovery in patients undergoing laparoscopic hysterectomy, to investigate its influencing factors, in order to provide evidence for clinical prevention and intervention and improve the quality of postoperative rehabilitation. Methods A total of 120 female patients who underwent elective laparoscopic hysterectomy in Zhangjiakou First Hospital from January 2021 to January 2024 were selected. Perioperative patient-related data were collected and divided into delirium group and non-delirium group according to whether delirium occurred during the postoperative anesthesia recovery period. The incidence of delirium during recovery from anesthesia in patients undergoing laparoscopic hysterectomy was observed. Univariate and multivariate logistic regression were used to analyze the independent risk factors for delirium during anesthesia recovery in patients undergoing laparoscopic hysterectomy. Results The incidence rate of delirium was 13.34% (16/120). Univariate and multivariate logistic regression analysis results showed that sleep disorder, use of dexmedetomidine before/during surgery, CO₂ pneumoperitoneum time, operation time, intraoperative blood loss, VAS score and the total amount of anesthetic drugs were factors that affect the occurrence of delirium in patients (P=0.006, 0.033, 0.004, 0.002, 0.010, 0.024 and 0.005; OR 95% CI: 1.501-11.659, 1.074-5.191, 1.287-3.826, 1.250-2.705, 1.310-7.211, 1.109-4.189, and 1.349-5.360). Conclusion Sleep disorder, preoperative/during use of dexmedetomidine, CO₂ pneumoperitoneum time, operation time, intraoperative blood loss, VAS score and total amount of anesthetic drugs are all factors that contribute to the occurrence of delirium during anesthesia recovery in patients undergoing laparoscopic hysterectomy. Clinical prevention and intervention should be actively targeted at the above risk factors.
- Hysterectomy /
- Anesthesia recovery period /
- Delirium /
- Risk factors

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表 1 2组择期行腹腔镜下子宫切除术患者一般资料比较

Table 1. Comparison of general data between the two groups of patients scheduled for laparoscopic hysterectomy

组别	例数	年龄 (x±s，岁)	文化程度(例)			吸烟史 (例)	饮酒史 (例)	高血压 (例)	糖尿病 (例)	睡眠障碍 (例)
组别	例数	年龄 (x±s，岁)	初中	高中	大学及以上	吸烟史 (例)	饮酒史 (例)	高血压 (例)	糖尿病 (例)	睡眠障碍 (例)
谵妄组	16	46.43±5.43	4	7	5	6	5	5	3	7
非谵妄组	104	47.00±6.21	18	54	32	13	27	12	5	19
统计量		0.347^a	0.343^b			6.503^c	0.198^c	4.431^c	4.332^c	5.305^c
P值		0.729	0.732			0.011	0.656	0.035	0.037	0.021
注：^a为t值，^b为Z值，^c为χ²值。

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表 2 2组择期行腹腔镜下子宫切除术患者实验室指标及手术资料比较

Table 2. Comparison of laboratory indicators and surgical data between the two groups of patients scheduled for laparoscopic hysterectomy

项目	谵妄组 (n=16)	非谵妄组 (n=104)	统计量	P值
手术前白细胞(x±s，×10⁹/L)	6.68±2.07	6.40±1.95	0.530^a	0.597
手术后白细胞(x±s，×10⁹/L)	8.33±2.39	8.28±2.18	0.084^b	0.933
手术前血红蛋白(x±s，g/L)	130.53±10.67	132.61±11.35	0.688^a	0.493
手术后血红蛋白(x±s，g/L)	115.42±18.47	113.97±17.40	0.308^b	0.759
ASA分级(例)			0.012^c	0.913
Ⅰ级	9	60
Ⅱ级	7	44
全麻方式(例)			0.039^c	0.844
静吸复合麻醉	11	74
全凭静脉麻醉	5	30
术前/中使用右美托咪定(例)			4.857^c	0.028
是	5	63
否	11	41
CO₂气腹时间(x±s，min)	95.86±21.86	73.98±17.70	4.457^a	＜0.001
手术时间(x±s，min)	202.94±82.29	179.98±69.32	6.319^a	＜0.001
术中出血量(x±s，mL)	122.97±31.87	87.01±27.42	4.778^a	＜0.001
VAS评分(x±s，分)	3.76±1.13	2.38±0.78	6.171^a	＜0.001
麻醉药物总量(x±s，mg)	489.57±112.58	360.75±97.53	4.818^a	＜0.001
注：^a为t值，^b为F值，^c为χ²值。

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表 3 腹腔镜子宫切除术患者发生谵妄的影响因素多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of influencing factors of delirium in patients undergoing laparoscopic hysterectomy

变量	B	SE	Waldχ²	P值	OR值	95% CI
吸烟史	0.983	0.652	2.273	0.132	2.672	0.745~9.592
高血压	1.288	0.890	2.432	0.120	4.007	0.700~22.929
糖尿病	1.287	0.775	2.758	0.098	3.622	0.793~16.544
睡眠障碍	1.431	0.523	7.486	0.006	4.183	1.501~11.659
术前/中使用右美托咪定	0.859	0.402	4.566	0.033	2.361	1.074~5.191
CO₂气腹时间	0.797	0.278	8.219	0.004	2.219	1.287~3.826
手术时间	0.609	0.197	9.557	0.002	1.839	1.250~2.705
术中出血量	1.123	0.435	6.665	0.010	3.074	1.310~7.211
VAS评分	0.768	0.339	5.132	0.024	2.155	1.109~4.189
麻醉药物总量	0.989	0.352	7.894	0.005	2.689	1.349~5.360
注：变量赋值如下，吸烟史，是=0，否=1；高血压，是=0，否=1；糖尿病，是=0，否=1；睡眠障碍，是=0，否=1；术前/中使用右美托咪定，是=0，否=1；CO₂气腹时间、手术时间、术中出血量、VAS评分、麻醉药物总量以实际值赋值。

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