全身麻醉患者术中知晓情况分析

目的明确应用目前全身麻醉方法行择期手术术中知晓的发生率,对可能引起术中知晓的原因进行分析。并对术中知晓病例的术后情况进行统计分析。方法随访接受全身麻醉的择期手术患者2025例,以准确回述记忆确定术中知晓。对存在术中知晓的患者记录知晓时的感知觉、心理反应,并于术后2周追踪有无后遗症状发生。采用多元Logistic回归分析对可能与术中知晓有关的因素进行分析。结果共28例（1．4％）患者存在术中知晓。女性（OR=2．836;95％ CI 1．181～6．810）,应用喉罩进行气道管理（OR=19．609;95％CI3．894～98．740）,麻醉维持过程中一段时间或全程未应用挥发性麻醉剂（OR=3．084;95％CI1．246～7．629）,术中血压波动（OR=10．430;95％CI3．918～27．763）的患者易发生术中知晓,应用术前药（OR=0．326;95％C10．110～0．965）有助于使发生术中知晓的危险性下降。而患者的年龄、体重、ASA分级、麻醉时间、术中是否复合应用阻滞麻醉、术中是否复合应用阿片类镇痛药对术中知晓的发生并没有显著影响。28例术中知晓患者中,23／28（82％）术中存在听觉;7／28（25％）术中存在不同程度的疼痛;10／28（36％）术中有恐惧和焦虑感;6／28（21％）术后出现不同程度的后遗症。结论术中知晓可在多种择期手术中散发。女性,应用喉罩进行气道管理,麻醉维持过程中一段时间未用或全程未用挥发性麻醉剂,术中出现血压波动,是全身麻醉患者术中知晓的可能危险因素,术前药物的应用对预防术中知晓有益。术中知晓的患者术后可能发生不同程度的后遗症。

Awareness with recall during general anesthesia: analysis of 2015 cases

OBJECTIVE: To investigate the incidence of awareness with recall during general anesthesia in elective operation with modern anesthetic methods and to analyze the risk factors thereof. METHODS: 2025 patients, 1001 males and 1024 females, aged 53 +/- 16, underwent general anesthesia during different kinds of elective operation. Interview was conducted 1 - 3 days postoperatively to survey the incidence of awareness during operation. Two weeks later follow-up was conducted again to know if sequelae existed. RESULTS: Twenty-eight patients (1.4%) were identified as with awareness. Multiple regression analysis showed that awareness during operation was associated with being female (OR = 2.836, 95% CI = 1.81 - 6.810), use of laryngeal mask airway (LMA, OR = 19.609, 95% CI = 3.918 - 98.740), not use volatile anesthetics at a time or continuously during maintenance of anesthesia (OR = 3.084, 95% CI = 1.246 - 7.629), and intra-operative blood pressure fluctuation (OR = 10.430, 95% CI = 3.918 - 27.763), Premedicated patients had lower incidence of awareness during operation (OR = 0.326, 95% CI = 0.110 - 0.965). Twenty-three of the 28 patients with awareness during operation (82%) had auditory perception, 2 (7%) had both auditory and visual perception, 7 felt pain at different degrees, and 10 (36%) felt anxiety during operation. After effects appeared in 6 of the 28 patients (21%). CONCLUSION: Awareness occurs in some patients undergoing elective operation. Being female, use of LMA, not using volatile anesthetics at a time or continuously during maintenance of anesthesia, and intra-operative blood pressure fluctuation are risk factors. Premedication may help prevent awareness during operation.