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Clinical investigation and coping strategies establishment of POFS in out-patients with painless gastroscopyObjective To elucidate POFS(postoperative fatigue syndrome)in out-patients with painless gastroscopy,screen the influencing factors and establish coping strategies.Methods From October 2016 to February 2017,the out-patients were treated with painless gastroscopy and gastroscopy.By reviewing literatures summarized the possible 35 influencing factors about general situation,pasthistory,intraoperative conditions,postoperative diagnosis etc.By polling preoperative,filling out by doctor during anesthesia,poilling before leaving hospital and interviewing by phone at postoperative 24h time point to fill in questionnaires,and evaluating POFS occurrence,the initial fatigue scale and duration.The patients were divided into fatigue group(group ?)and no fatigue group(group ?)of painless colonoscopy according to the presence of POFS.Multi variate Logistic regression analysis was used to analyze the independent influencing factors of POFS for group ?,the independent influencing factors were analyzed and the coping strategies were put forward.Results In the painless gastroscopy group(group A),259 cases were included,13 cases were lost,and finally 246 cases completed the investigation,69 cases appeared POFS,the probability of occurrence was 28.04%,the initial fatigue score was 5.19±2.36 and the duration was 6.64 ±8.62h.In the gastroscopy group(group B),266 cases were included,12 cases were lost,and finally 254 cases completed the investigation,12 cases appeared POFS,the probability of occurrence was 4.72%,the initial fatigue score was 3.17 ± 0.58,and the duration was 2.38 ± 2.73h.Logistic regression analysis showed that the average amount of propofol(by anesthesia time,mg/min)was an independent factor in POFS.The ROC curve of this factor shows that ithas a certain effect on the occurrence of fatigue.The AUC is 0.600.The optimal cutoff point is 25.75 mg/min.Further Logistic regression analysis showed that the probability of fatigue in the mean dose of propofol(mg/min)>25.75 mg/min group was significantly lower than that in the mean dose of propofol(mg/min)<25.75 mg/min group which was 0.376 times.Conclusions The average amount of propofol(by anesthesia time,mg/min)was the independent influencing factor of POFS after painless colonoscopy.Appropriate increase the amount of propofol per unit time,deepen the depth of anesthesia can effectively reduce the occurrence of postoperative fatigue.Part ? Clinical investigation andcoping strategies establishment of POFS in out-patients with painless colonoscopyObjective To elucidate POFS(postoperative fatigue syndrome)in out-patients with painless colonoscopy,screen the influencing factors and establish warning model.Methods From October 2016 to February 2017,the out-patients were treated with painless colonoscopy and colonoscopy.By reviewing literatures summarized the possible 36 influencing factors about general situation,pasthistory,intraoperative conditions,postoperative diagnosis etc.By polling preoperative,filling out by doctor during anesthesia,poilling before leaving hospital and interviewing by phone at postoperative 24h time point to fill in questionnaires,and evaluating POFS occurrence,the initial fatigue scale and duration.The painless colonoscopy patients were divided into remifentanil group(group r),sufentanil group(group s),fentanyl group(group f)and dizosin group(group d)according to different analgesic choice,and were divided into fatigue group(group ?)and no fatigue group(group ?)according to the presence of POFS.Multivariate Logistic regression analysis was used to analyze the independent influencing factors of POFS for group ?,the independent influencing factors were analyzed and the warning model were put forward.Results In the painless colonoscopy group(group A),468 cases were included,27 cases were lost,and finally 441 cases completed the investigation,129 cases appeared POFSs,the probability of occurrence was 29.25%,the initial fatigue score was 5.73 ± 2.60 and the duration was 7.51 ±11.33h.In the colonoscopy group(group B),130 cases were included,5 cases were lost,and finally 125 cases completed the investigation,8 cases appeared POFSs,the probability of occurrence was 6.40%,the initial fatigue score was 4.75 ± 1.58,and the duration was 31.31 ± 32.00h.The initial fatigue score in group A was significantly higher than that in group B(P<0.05).The duration of group B was significantly higher than that of group A(P<0.05).The probability of POFS occurrence in group d was significantly higher than that in group r,group s and group f(P<0.05),and there was no significant difference among the group r,group s and group f(P>0.05).The initial fatigue score in group d was significantly higher than that in group r and group f(P<0.05),and no significant difference with group s(P>0.05).The duration of group s and group d was significantly longer than that of group r and group f(P<0.05),and there was no statistical difference between group s and group d,group r and group f(P>0.05).The results of Logistic regression analysis showed that sex,waiting time of the day,type of painkiller and percentage of heart rate change after induction were independent influencing factors of POFS,and the waiting time could predict the occurrence of fatigue,AUC was 0.623.The optimal truncation point was chosen according to the principle of the maximum Jordan exponent.The results showed that the optimal truncation point was 1.125.The probability of fatigue in the group with waiting time greater than 1.125h lower than that in the group with waiting time less than 1.125h which was 0.363 times.According to the above statistical results,the warning model was established and the AUC was 0.716,assuming that the test had statistical significance(P<0.001).The probability of prediction was 0.2625,the sensitivity was 0.729,the specificity was 0.628,and the Jordan exponent was 0.357.Conclusions Using dezocine and higher percentage of heart rate change after induction were independent risk factors;male and prolonging the waiting time of the day appropriate was the protective factors of POFS.According to the warning model which was established by above information,the relevant high-risk population could be screened. |
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