Risk Factors Influencing Quality of Intraoperative Wake-up Test for Extremely Severe Scoliosis Surgery
1.Department of Anesthesiology，the Third People's Hospital of Chengdu，Southwest Jiaotong University
2.Center of Cardiac Surgery，Sichuan Academy of Medical Sciences & Sichuan Provincial-People’s Hospital
3.Department of Orthopedics，the Third People's Hospital of Chengdu，Southwest Jiao Tong University
摘要目的 探讨极重度脊柱侧凸矫形术中唤醒质量的影响因素。方法 收集2013年1月至2018年4月拟行脊柱矫形术的先天性极重度脊柱侧凸的513例患者临床资料。其中男性196例，女性317例；年龄13~34岁，平均(28.5±4.1)岁。患者术前主弯Cobb角平均为(137.5±26.8)°。根据唤醒质量将患者分为优良组及差组，采用单因素分析和多因素logistic回归分析分析可能影响患者术中唤醒质量的18项临床因素。结果 单因素分析显示，第1秒用力呼气容积(forced expiratory volume in one second，FEV-1)、第1秒用力呼气量占用力肺活量比值(ratio of forced expiratory volume in one second to forced vital capacity，FEV-1/FVC)、唤醒前体温、唤醒前动脉二氧化碳分压(arterial CO-2 partial pressure，PaCO-2)、唤醒前血红蛋白(hemoglobin，Hb)与极重度脊柱侧凸矫形术中唤醒质量有关(P＜0.05)。多因素logistic回归分析显示，唤醒前体温(OR=1.973，95%CI：1.817~4.129，P＜0.05)、唤醒前PaCO-2(OR=15.561，95%CI：6.278~33.368，P＜0.05)、唤醒前Hb(OR=6.413，95%CI：3.460~14.653，P＜0.05)是影响极重度脊柱侧凸矫形术中唤醒质量的独立危险因素。结论 极重度脊柱侧凸矫形术中唤醒质量与唤醒前体温、唤醒前PaCO-2、唤醒前Hb有关，做好围术期管理是提高术中唤醒质量的关键。
Abstract：Objective To investigate the risk factors influencing the quality of intraoperative wake-up test undergoing scoliosis surgery.Methods The clinical data of 513 patients with extremely severe scoliosis between January 2013 and April 2018 were reviewed.Among them，196 were male and 317 were female；age ranged from 13 to 34 years，with a mean of (28.5±4.1) years.The mean preoperative main curve Cobb angle of the patients was (137.5±26.8)°.A total of 18 potential factors associated with poor quality of intraoperative wake-up test were evaluated by univariate analysis and multivariate logistic regression analysis.Results The univariate analysis showed that forced expiratory volume in one second(FEV-1)，ratio of forced expiratory volume in one second to forced vital capacity (FEV-1/FVC)，body temperature，arterial CO-2 partial pressure(PaCO-2)，hemoglobin(Hb) were significantly influenced the quality of intraoperative wake-up test (P＜0.05).Multivariate logistic regression analysis showed that body temperature (OR=1.973，95%CI：1.817~4.129，P＜0.05)，PCO-2 (OR=15.561，95%CI：6.278~33.368，P＜0.05)，Hb (OR=6.413，95%CI：3.460~14.653，P＜0.05) were independent risk factors for the quality of intraoperative wake-up test undergoing scoliosis surgery.Conclusion Body temperature，PaCO-2，Hb are independent risk factors for the quality of intraoperative wake-up test undergoing scoliosis surgery.
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