Research Unit of Clinical Nursing, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2019 Oct;63(9):1137-1142. doi: 10.1111/aas.13420. Epub 2019 Jun 26.
The post-anaesthetic phase is most often uncomplicated, but patients may experience inadequate emergence (IE) characterized by unrest, restlessness, aggressiveness or in contrast sedation or lack of initiative. This may increase length of stay (LOS) and post-operative complications. The aim of this study was to investigate frequency, risk factors and consequences of IE.
We conducted an observational cohort study including 1000 orthopaedic and abdominal surgical patients, screened with the Nursing Delirium Screening Scale (Nu-DESC) before induction of anaesthesia, at arrival at the post-operative care unit, and just before discharge from PACU. IE was defined as a Nu-DESC score ≥2 after surgery. Predictors included surgical procedure, type and duration of anaesthesia, age, ASA-score, sex and post-operative pain. Data were analysed during adjusted logistic regression and Wilcoxon rank sum test, the primary outcome being LOS.
IE occurred in 103 of 1000 patients (10.3%, 95% CI 8.6-12.3%). LOS was median 2 vs 1 day in patients with and without IE, mean difference was 1.3 (SD 6.2) days (P = 0.036). Thirty-day mortality was 2.9 vs 1.0% (P = 0.92) and admission to ICU 1.0 vs 0.9% (P = 0.66) in patients with and without IE. Significant associations to IE were found for inhalational anaesthetics (OR 2.65; 95% CI: 1.57-4.46), duration of anaesthesia ≥2 hours (OR 1.98; 95% CI: 1.14-3.44) and ASA-score ≥3 (OR 2.74; 95% CI: 1.64-4.57).
One of 10 patients had IE as defined by the Nu-DESC score, which was significantly associated with increased LOS. Longer duration of anaesthesia, inhalational anaesthesia and ASA ≥3 were significantly associated to this.
麻醉后阶段通常是平稳的，但患者可能会经历苏醒不足（IE），表现为不安、躁动、攻击性，或者相反地表现为镇静或缺乏主动性。这可能会增加住院时间（LOS）和术后并发症。本研究旨在调查 IE 的频率、危险因素和后果。
我们进行了一项观察性队列研究，纳入了 1000 例骨科和腹部手术患者，在麻醉诱导前、到达术后护理单元时以及从 PACU 出院前使用护理谵妄筛查量表（Nu-DESC）进行筛查。IE 定义为手术后 Nu-DESC 评分≥2。预测因素包括手术程序、麻醉类型和持续时间、年龄、ASA 评分、性别和术后疼痛。数据分析采用调整后的逻辑回归和 Wilcoxon 秩和检验，主要结局是 LOS。
1000 例患者中有 103 例（10.3%，95%CI 8.6-12.3%）发生 IE。IE 患者和无 IE 患者的 LOS 中位数分别为 2 天和 1 天，平均差异为 1.3 天（SD 6.2）（P=0.036）。IE 患者和无 IE 患者的 30 天死亡率分别为 2.9%和 1.0%（P=0.92），入住 ICU 分别为 1.0%和 0.9%（P=0.66）。与 IE 显著相关的因素包括吸入性麻醉剂（OR 2.65；95%CI：1.57-4.46）、麻醉时间≥2 小时（OR 1.98；95%CI：1.14-3.44）和 ASA 评分≥3（OR 2.74；95%CI：1.64-4.57）。
以 Nu-DESC 评分定义，10 例患者中有 1 例发生 IE，与 LOS 增加显著相关。麻醉时间较长、吸入性麻醉和 ASA≥3 与 IE 显著相关。
