关键词: 胸腔镜肺叶切除术, 全身麻醉, 苏醒期, 苏醒延迟, 影响因素

Abstract: Objective To investigate the incidence of delayed emergence during the recovery period from general anesthesia and its associated factors in patients undergoing thoracoscopic lobectomy.Methods A retrospective study was conducted on 252 patients who underwent thoracoscopic lobectomy under general anesthesia at our institution between February 2022 and June 2025.Patients were divided into a delayed emergence group and a control group based on whether delayed emergence occurred during the recovery period from general anesthesia.Clinical data were collected from both groups.Independent influencing factors for delayed emergence during the recovery period from general anesthesia were identified,and a Logistic regression prediction model was established.Model discrimination was assessed using the area under the receiver operating characteristic (ROC) curve (AUC) and the concordance index (C-index) derived via the Bootstrap method,and model calibration was subsequently evaluated.Results Of the 252 patients who underwent thoracoscopic lobectomy under general anesthesia,51 (20.24%) experienced delayed emergence during the recovery period.Multivariate unconditional Logistic regression analysis revealed that preoperative frailty (OR=2.853),intraoperative hypothermia (OR=2.639),intraoperative fluid infusion volume (OR=1.002),intraoperative sufentanil dosage (OR=1.190),and anesthesia duration (OR=1.017) were all independent risk factors for delayed emergence during the recovery period from general anesthesia in patients undergoing thoracoscopic lobectomy (all P<0.05).A -Logistic regression prediction model was established as follows:Logit(P)=Logit(P)=-13.891+1.048×preoperative frailty (yes=1,no=0)+0.017×anesthesia duration (min)+0.002×intraoperative fluid volume (ml)+0.971×intraoperative hypothermia (yes=1,no=0)+0.174×intraoperative sufentanil dosage（μg）.ROC curve analysis demonstrated that the AUC of the regression prediction model for predicting delayed emergence during the recovery period from general anesthesia was 0.833 (95%CI:0.769-0.896).Internal validation using the Bootstrap method yielded a C-index of 0.836.The Hosmer-Lemeshow goodness of fit test indicated χ2=12.648,P=0.125.The calibration curve demonstrated good agreement between the predicted curve of the regression model and the ideal curve,with a mean absolute error of 0.012.Conclusion The incidence of delayed emergence during the recovery period from general anesthesia remains relatively high in patients undergoing thoracoscopic lobectomy.The associated factors include preoperative frailty,anesthesia duration,intraoperative hypothermia,intraoperative fluid infusion volume,and intraoperative sufentanil dosage.The Logistic regression prediction model constructed accordingly demonstrates satisfactory predictive performance.

Key words: thoracoscopic lobectomy, general anesthesia, recovery period, delayed emergence, influencing factors