全身麻醉苏醒期躁动研究进展

doi:10.3969/j.issn.1674-8115.2026.10.011

摘要/Abstract

摘要：

全身麻醉苏醒期躁动（emergence agitation，EA）是一种常见的术后并发症，以定向障碍、意识与行为分离及非目的性躁动为主要表现。它不仅显著增加意外拔管、手术部位出血等围手术期不良事件风险，增加医疗护理负担，还可能对患者远期神经认知功能造成损害。EA的发生是患者自身因素、麻醉用药与手术相关刺激共同作用的结果，病因复杂，增加了临床管理难度。传统手段多为右美托咪定、丙泊酚等药物的经验性防治，尚缺乏针对高危人群的早期识别与个体化用药方案。近年来，针对EA的研究已取得一定进展。在发病机制方面，多维度探索为临床精准干预提供了潜在靶点。同时，代谢与炎症标志物以及脑电特征等客观指标，在一定程度上提升了风险预测的能力。此外，部分非药物措施也展现出良好的应用前景。该文系统梳理EA的危险因素、病理生理机制、预测指标、评估工具及防治策略，并整合循证医学证据，明确不同人群、不同手术类型的个体化管理要点，为临床麻醉医师制定EA防控方案提供参考，以期推动EA防治向精准化、标准化方向发展。

关键词: 苏醒期躁动, 全身麻醉, 病理生理机制, 风险预测, 预防, 治疗

Abstract:

Emergence agitation (EA) following general anesthesia is a common postoperative complication, characterized primarily by disorientation, a dissociation between consciousness and behavior, and non-purposeful restlessness. It not only significantly increases the risk of perioperative adverse events such as accidental extubation and surgical site bleeding, but also increases the medical and nursing burden, and may cause long-term neurocognitive impairment in patients. The occurrence of EA results from the interaction of patient-related factors, anesthetic agents, and surgery-related stimuli, and the complexity of its etiology poses considerable challenges to clinical management. Traditional strategies predominantly rely on the empirical use of medications such as dexmedetomidine and propofol for prevention and treatment, yet early identification of high-risk populations and individualized pharmacological regimens remain limited. In recent years, research on EA has made notable progress. Multidimensional explorations of its pathogenesis have provided potential targets for precise clinical intervention. Meanwhile, objective indicators such as metabolic and inflammatory markers and electroencephalographic (EEG) features have improved risk prediction to a certain degree. Furthermore, certain non-pharmacological measures have also demonstrated favorable application prospects. This review aims to systematically summarize the risk factors, pathophysiological mechanisms, predictive indicators, assessment tools, and prevention and treatment strategies for EA, and to integrate evidence-based medical evidence to clarify the key points of individualized management across different patient populations and surgical types, thereby providing a reference for anesthesiologists in formulating EA prevention and control strategies and promoting the prevention and treatment of EA toward precision and standardization.

Key words: emergence agitation (EA), general anesthesia, pathophysiological mechanism, risk prediction, prevention, treatment

中图分类号:

R614.2

罗骥, 赵志颖, 杨谦梓, 罗艳. 全身麻醉苏醒期躁动研究进展[J]. 上海交通大学学报（医学版）, 2026, 46(10): 1412-1419.

Luo Ji, Zhao Zhiying, Yang Qianzi, Luo Yan. Research progress in emergence agitation during general anesthesia[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026,(10): 1412-1419.

图/表 1

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