基于常规临床指标的老年患者全麻术后苏醒时间延长相关因素回顾性分析

Retrospective Analysis of Factors Associated with Delayed Emergence from General Anesthesia in Elderly Patients Based on Routine Clinical Indicators

摘要: 目的：探讨基于常规临床指标的老年患者全身麻醉(全麻)术后苏醒时间延长的相关因素，为手术室围术期护理风险评估与针对性干预提供参考依据。方法：回顾性选取珠海市中西医结合医院2024年1月至2026年5月收治的行全麻手术的92例老年患者为研究对象，收集其一般资料、术前资料、术中资料及麻醉复苏资料等常规临床指标。按苏醒延迟经典定义(全麻停止给药后超过30 min意识仍未恢复)，本组患者均无苏醒延迟(原始数据“是否苏醒延迟”均为0)；结合本研究数据分布特征(苏醒时间第75百分位数为10 min)，以苏醒时间 ≥ 10 min作为苏醒时间延长的操作性判定界值，将患者分为苏醒时间延长组(32例)与非苏醒时间延长组(60例)，比较两组各项临床指标的差异，采用Spearman相关分析及多因素Logistic回归分析筛选老年患者全麻术后苏醒时间延长的相关因素。结果：按操作性判定界值，92例老年患者中苏醒时间延长32例，占34.8%。单因素分析显示，两组患者年龄、性别、身高、体质量、体质量指数(BMI)、ASA分级、术前合并症、血红蛋白、白蛋白、手术级别、麻醉方式、手术时长、麻醉时长、术中出血量、术中输液量、术中低血压事件次数、最低体温及麻醉后监测治疗室(PACU)停留时间比较，差异均无统计学意义(P > 0.05)。多因素Logistic回归分析显示，合并高血压(OR = 2.989, 95% CI: 1.109~8.052)与老年患者全麻术后苏醒时间延长独立相关(P < 0.05)；麻醉时长(OR = 0.991, 95% CI: 0.984~0.999)及合并脑血管疾病(OR = 0.056, 95% CI: 0.005~0.687)均与苏醒时间延长呈负相关(P < 0.05)；合并慢性阻塞性肺疾病与苏醒时间延长呈正相关趋势(OR = 13.437, P = 0.061)。结论：在本研究操作性判定界值下，老年患者全麻术后苏醒时间延长者占34.8%，合并高血压与其独立相关。手术室护理人员应重视对合并高血压老年患者的术前评估、术中循环与保温管理及麻醉复苏期监护，以缩短麻醉苏醒时间、降低苏醒时间相对延长的风险。本研究中麻醉时长、脑血管疾病与苏醒时间延长的负相关结果可能受样本量及回顾性研究偏倚影响，有待扩大样本量进一步验证。

Abstract: With the rapid development of digital media and generative artificial intelligence technology, the speed of information production and dissemination is accelerating, and the production mode of literary texts has also undergone profound changes. Whether the continuous increase of information quantity means that people’s thoughts, aesthetic experience and spiritual life are synchronously enriched, and whether the continuous expansion of text generated by artificial intelligence means the improvement of literary creativity has become a problem that literary research needs to face again in the digital age. In this paper, Han Bingzhe’s “In the crowd” on the “increase of information is not equal to increase of thoughts” and the digital media changing people’s perception mode as a theoretical starting point, combined with Benjamin’s thinking on the changes of modern technology media and people’s perceptual knowledge mode, and Zhu Guangqian’s related discussion on aesthetic perception, aesthetic distance and artistic creation, to investigate the changes of people’s aesthetic perception in the digital media environment and its internal relationship with the generation of AI literature. Firstly, this paper analyzes how the information proliferation, algorithm recommendation and fragmented communication of digital media change people’s attention structure and aesthetic acceptance mode, so that aesthetic activities gradually tend to be instant, rapid and typed, and points out that rich information does not necessarily bring rich aesthetic experience. Secondly, taking Apostle of Destiny and Land of Machine Memory as cases, this paper analyzes the basic path of generative artificial intelligence from information transfer and language reorganization to large-scale text production, distinguishes the novelty of AI-generated texts from the innovation of experience and thought, and points out that the increase of text quantity and the change of text form do not necessarily mean the generation of new literary experience and thought. Finally, starting from the distinction between “producing text” and “creating experience”, this paper reconsiders the significance of literary creation in the era of artificial intelligence, and holds that the value of literature is not mainly reflected in the increase of knowledge and text, but in changing people’s perception mode through new aesthetic experience, so that readers can break through the existing information and meaning structure, and thus realize a new understanding of themselves and the world. Therefore, the key issue of literature research in the AI era should not only be whether artificial intelligence can write literature, but also whether the text generated by it can create new experiences and why literature can maintain its irreplaceability in the era of infinite text production.