摘要目的 筛选全麻患者术后残余肌松的危险因素及初步建立预警评分系统.方法 选择全麻后返回恢复室发生残余肌松患者369例,随机匹配未发生残余肌松患者740例.对组间差异有统计学意义的因素进行logistic回归分析,筛选发生术后残余肌松的独立危险因素.根据各危险因素的比值比,初步建立预警评分系统,应用受试者工作特征曲线下面积评价其预测能力.结果 logistic回归分析结果显示:顺式阿曲库铵用量＞0.4mg· kg-1·h-1、末次给肌松药距手术结束时间＜60min和术中入液量＞20 ml/kg是全麻患者术后出现残余肌松的独立危险因素.初步建立了残余肌松预警评分系统,受试者工作特征曲线下面积为0.82,预测残余肌松的最佳界值,即cut-off值为1.5(灵敏度为63.5％、特异度为82.7％、Youden指数为0.462),从而初步确定风险分层标准,即评分≤1分预示低危风险,评分≥2分预示高危风险.结论 顺式阿曲库铵用量＞0.4 mg· kg-1 ·h-1、末次给肌松药距手术结束时间＜60 min和术中入液量＞20 ml/kg是全麻患者术后出现残余肌松的独立危险因素;初步建立的预警评分系统预测术后残余肌松的准确性较高.

abstractsObjective To determine the risk factors for postoperative residual paralysis in patients undergoing general anesthesia and establish the warning score system initially.Methods A total of 369 patients who underwent general anesthesia and developed residual paralysis after returning to the recovery room and 740 patients who did not developed residual paralysis were enrolled in the study.Logistic regression was used to analyze the factors of which P values were less than 0.05 to identify the independent risk factors for postoperative residual paralysis.The warning score system was established initially according to the odds ratios of each risk factor,and the area under receiver operating characteristic curve was used to evaluate the predicting ability of the system.Results Logistic regression analysis showed that the consumption of cisatracurium more than 0.4 mg · kg-1 · h-1,time from the last administration of muscle relaxants to the end of operation less than 60 min and volume of intraoperative fluid infused more than 20 ml/kg were independent risk factors for postoperative residual paralysis in patients undergoing general anesthesia.The warning score system of residual paralysis was established initially,and the area under receiver operating characteristic curve was 0.82.The best cut-off value of predicting residual paralysis was 1.5 (sensitivity 63.5％,specificity 82.7％,Youden index 0.462),and thus the risk stratification criteria were determined initially with score less than or equal to 1 predicting low risk,and score more than or equal to 2 predicting high risk.Conclusion The consumption of cisatracurium more than 0.4 mg · kg-1 · h-1,time from the last administration of muscle relaxants to the end of operation less than 60 min and volume of intraoperative fluid infused more than 20 ml/kg are independent risk factors for postoperative residual paralysis in patients undergoing general anesthesia;the initially established warning score system produces higher accuracy in predicting postoperative residual paralysis.