全身麻醉患者发生术中知晓的临床特征和对策

目的: 分析全身麻醉患者发生术中知晓的发生率、高危因素及特征,探讨其防治措施。方法:回顾性分析我院2005年-2010年全身麻醉患者中发生术中知晓的28例病例。结果:全身麻醉患者术中知晓的发生率为0.07%;该组病例特征为:①男性的发生率大于女性;②多见于麻醉手术时间小于1h的"短小手术";③麻醉方式主要表现在静脉复合麻醉中,但均未使用苯二氮卓类药;④长期口服"安眠药"和长期饮酒的患者发生率高,且术中未实施脑功能监测;⑤术后一定时间内存在较严重的心理和精神障碍,但治疗效果明显。结论:全身麻醉期间发生术中知晓可对患者造成严重的心理和精神障碍;应加强术前评估和预防,特别是男性、短小手术和长期使用安眠类药物等高危患者尤其应预防性地使用苯二氮卓类药+以吸入麻醉为主的复合麻醉,术中应实施BIS等监测;重视术后回访和及时的心理和药物治疗。

Countermeasure and Clinical Analysis of Intraoperative Awareness of Patients Undergoing General Anesthesia

Objective:To analyze the Incidence,risk factors and characteristics intraoperative awareness of patients undergoing general anesthesia and explore the prevention and control measures.Methods:28 cases of intraoperative awareness undergoing general anesthesia were analyzed retrospectively in our hospital from 2005 to 2010.Results:The incidence of intraoperative awareness was 0.07%;The characteristics of the group of patients:①The prevalence was greater in men than in women;②More common in anesthesia in less than 1h of the "short operation";③Awareness during intravenous anesthesia was higher than that of other ways,but also case of all did not use benzodiazepine drugs;④It was higher in the patients with long-term drinking and using diazepam for a long time,and intraoperative monitoring of brain function is not implemented;⑤Postoperative period were with serious psychological and mental disorders,But the treatment was obviously effective.Conclusion:Awareness of patients undergoing general anesthesia during surgery in patients can cause severe psychological and mental disorders;We should strengthen the preoperative evaluation and prevention of high-risk patients such as men,short operation and long-term using diazepam for a long time,and especially preventive use of benzodiazepines drugs.BIS monitoring should be implemented;Pay attention to the return visit and timely psychological and drug treatment.