先天性心脏病介入患儿术后苏醒期躁动危险因素分析-现代医学

先天性心脏病介入患儿术后苏醒期躁动危险因素分析

单位：南京医科大学附属儿童医院麻醉科, 江苏南京 210019

分类号：R725.4

出版年·卷·期（页码）：2025·53·第三期（462-468）

摘要：

目的：先天性心脏病(CHD)患儿经历介入手术后易出现苏醒期躁动(EA)，本研究旨在探索影响CHD患儿介入术后发生EA的危险因素。方法：采用病例对照研究设计，纳入2024年5月至10月南京医科大学附属儿童医院心血管内科收治符合纳入及排除标准的169例CHD患儿，将其分为躁动组(44例)及无躁动组(125例)。比较两组患者相关指标差异，确定相关影响因素，采用多因素 Logistic 回归分析CHD患儿介入术后EA的危险因素。结果：在麻醉复苏室发生EA患儿44例，EA发生率为26%。单因素分析显示，CHD类型(χ²=13.506，P=0.001)，手术类型(χ²=35.659，P<0.001)，手术时长(t=6.769，P<0.001)，苏醒时长(t=2.198，P=0.029)，麻醉镇痛用药(χ²=19.508，P<0.001)，患儿术前焦虑(χ²=4.744，P=0.029)，陪护者焦虑(χ²=4.931，P=0.026)以及术后疼痛(χ²=53.917，P<0.001)在两组间分布差异均有统计学意义。而术中维持用药(χ²=3.353，P=0.067)，术后排尿困难(χ²=2.618，P=0.106)，病房环境(χ²=3.207，P=0.073)在两组间分布差异无统计学意义。多因素logistic回归分析结果显示，手术时长(OR=1.101, 95%CI: 1.057~1.147, P<0.001)、术后疼痛(OR=0.112, 95%CI: 0.031~0.399, P<0.001)是CHD患儿介入术后 EA的独立危险因素。结论：缩短手术时长及有效的术后镇痛可能降低CHD患儿介入术后EA的发生。

Objective: Children with congenital heart disease(CHD) are prone to emergence agitation(EA) after interventional surgery, this study aims to identify the risk factors for EA in CHD children after interventional surgery. Methods: A case-control study design was employed, incorporating 169 CHD children who met the inclusion and exclusion criteria and were admitted to the cardiovascular department of Children's Hospital of Nanjing Medical University from May to October 2024. The patients were divided into agitation group(44 cases) and non-agitation group(144 cases). Differences in relevant indicators between the two groups were analyzed to determine influence factors. Multivariate Logistic regression analysis was conducted to identify risk factors for EA in CHD children after interventional surgery. Results: A total of 44 cases of EA were occurred in anesthesia resuscitation room, with an incidence rate of 26%. The univariate analysis revealed that there were statistically significant differences in CHD type(χ²=13.506, P=0.001), surgical type(χ²=35.659, P<0.001), surgical duration(t=6.769, P<0.001), recovery time(t=2.198, P=0.029), anesthetic analgesia medication(χ²=19.508, P<0.001), preoperative anxiety of the child(χ²=4.744, P=0.029), anxiety of the attendant(χ²=4.931, P=0.026), and postoperative pain(χ²=53.917, P<0.001) between the two groups. No statistically significant differences were found between the two groups in intraoperative maintenance medication(χ²=3.353, P=0.067), postoperative difficulty in urination(χ²=2.618, P=0.106), and ward environment(χ²=3.207, P=0.073). Multivariate Logistic regression analysis showed that surgical duration(OR=1.101, 95%CI 1.057-1.147, P<0.001) and postoperative pain(OR=0.112, 95%CI 0.031-0.399, P<0.001) were independent risk factors for EA in CHD children after interventional surgery. Conclusion: Shortening surgical duration and providing effective postoperative analgesia may reduce the incidence of EA in CHD children after interventional surgery.

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