ABSTRACT
Objective To analyze the risk factors of respiratory depression occurring during recovery period in patients after having undergone general anesthesia and laparoscopic operation.Methods A total of 374 patients after general anesthesia and laparoscopic surgery admitted to the First Affiliated Hospital of Wenzhou Medical University from June 2015 to June 2016 were enrolled, they were divided into with or without the incidence of respiratory depression two groups by whether or not respiratorydepression, with the incidence of respiratory depression group 52 cases, without the incidence of respiratory depression group 322 cases. The patients' gender, age, body mass index (BMI), operation time, anesthesia maintenance mode, artificial airway mode, operative type and medication used in operation, intra-operative hypotension presence or absence, and type of operation were recorded. Univariate and multivariate logistic regression analyses were used to evaluate the risk factors of respiratory depression occurring in the recovery period after general anesthesia; receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of age, intraoperative medication, and age combine with intraoperative medication respectively in the occurrence of respiratory depression during recovery period after general anesthesia and lapatoscopic operation.Results Univariate analyses showed that there were no statistical significant differences in gender, BMI, operation time, anesthesia maintenance mode, artificial airway mode, intra-operative hypotension presence or absence, type of operation, etc. compared between patients with and without the incidence of respiratory depression groups (allP > 0.05); while the differences were statistically significant in age and drug used in the operation (dezocine, flurbiprofen, dexmedetomidine or dezocine combined with dexmedetomidine, allP < 0.05). Multivariate analyses showed that age and medication used in operation were the independent risk factors for the occurrence of respiratory depression during the anesthesia recovery stage (P values being 0.000, 0.002 respectively). ROC curve showed that age, intra-operative medication and age combine with intraoperative medication respectively had certain predictive value for the occurrence of respiratory depression during the recovery period after general anesthesia and laparoscopic surgery, the area under the ROC curve (AUC) of age combine with intraoperative medicationfor prediction of occurrence of respiratory depression during recovery period after anesthesia and laparoscopic surgery was significantly larger than that of single age or single intraoperative medication (0.826 vs. 0.668, 0.750,P < 0.01), 95% confidence interval (95%CI) of age, intraoperative medication and age combined with intraoperative medication were 0.598-0.738, 0.670-0.830, 0.764-0.888, the sensitivity, specificity and accuracy rate of age combine with intraoperative medication were 53.8%, 94.4% and 88.8%, respectively.Conclusion Elderly patients undergoing general anesthesia and laparoscopic operation and dezocine, dexmedetomidine or dezocine combined with dexmedetomidine being applied in the laparoscopic operation are more easily associated with incidence of respiratory depression during recovery period of anesthesia.
ABSTRACT
OBJECTIVE:To improve the system of management and maintenance for the purification air-conditioning system in PIVAS,and to further strengthen the management of cleaning environment. METHODS:The cleanness monitoring project of purifi-cation air-conditioning system in PIVAS of our hospital was introduced in terms of temperature and humidity record,pressure differ-ence record,airborne particles detection,settling microbe monitoring report. And the monitoring results were analyzed. RESULTS:The temperature and humidity,pressure difference of clean area in PIVAS of our hospital are both in line with the standard of Phar-macy Intravenous Admixture Quality Management Specification (2010 edition),i.e. temperature at 18-26 ℃,relative humidity of 40%-65%;negative pressure difference between antibiotics,hazardous drug dispensing area and second dressing room are 5-10 Pa. The number of airborne particles (average static particle/m3) at various cleanness degrees in clean area are all in line with the standard of GMP(2010 edition),i.e. maximal allowable number of airborne particles(≥0.5 μm)were 3 520/m3(100 degree);352 000/m3 (10 000 degree);3 520 000/m3 (100 000 degree). The percentage of qualified static settling microbe detection reach 100%in clean area,which is in line with the standard of Settling Microbe Detection Method in Clean Room(Area) of Pharmaceu-tical Industry,i.e. criteria for settling microbe(90 mm)CFU/0.5 h≤1(100 degree);≤3(10 000 degree);≤10(100 000 degree). The percentage of qualified dynamic settling microbe detection is in low level,especially those of dispensing room and secondary dressing room only reaches 80%. CONCLUSIONS:It’s important for effective hospital infection control in PIVAS,the quality im-provement of intravenous injection,the safety guarantee of drug use in patients to further improve standard operation procedure of purification air-conditioning system management and maintenance,and manage and maintain the purification air-conditioning sys-tem completely and scientifically.