全身麻醉患者术中知晓状况180例临床研究

目的:明确全身麻醉下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。方法:随访单纯全身麻醉和全身麻醉复合阻滞麻醉的择期手术患者共180例,术后1～3 d回访。对存在术中知晓的患者记录知晓时的感知觉、心理反应,进行回归分析对可能与术中知晓有关的因素进行分析。结果:180例中共有4例患者(2.2%)发生术中知晓。年龄是发生术中知晓的影响因素。结论:术中知晓可在多种择期手术中散发。年龄是全身麻醉患者术中知晓的影响因素。发生无痛知晓的患者术中及术后并没有出现明显的焦虑和后遗症。     

瑞马唑仑的临床应用优势分析

瑞马唑仑作为一种新型的苯二氮卓类药物,可用于全身麻醉的诱导、维持以及短小手术的程序镇静。与临床中常用的镇静药物丙泊酚相比,起效快,恢复快,对循环、呼吸的抑制作用小,注射痛发生率低,且有特异性的拮抗剂氟马西尼。此综述就瑞马唑仑在门诊短小手术和特殊类型手术全身麻醉中的应用优势进行分析。     

颌面外科全麻病人术中知晓调查及护理干预

目的:调查全麻下颌面外科患者术中知晓的发生率,并分析其可能发生的原因,探索预防和治疗的护理措施.方法:选择330例全麻下手术患者,术后1～3 d内对其术中知晓情况进行调查,分析影响患者术中知晓因素并采取针对性的护理措施.结果:330例手术患者中术中知晓患者有4例(1.2％),其中1例感知疼痛并听到医务人员谈话;2例仅听到医务人员谈话;1例仅有做梦感.结论:护士应做好全麻患者术前访视、麻醉诱导期注意手术室环境和配合好麻醉医生麻醉工作、术中注意减少知晓发生因素、术后做好心理护理及随访工作,护士应掌握相关的麻醉知识,积极配合麻醉医生,预防术中知晓发生,以减少患者术后的不良心理应激.     

全身麻醉患者术中知晓的临床分析

目的 分析全身麻醉患者术中知晓的发生率及可能原因.方法行全身麻醉的择期手术病人1 000例,男女各半,年龄18～65岁.术后第1天及第4天随访患者,调查术中知晓发生率.结果 1 000例患者中,发生术中知晓的有12例(1.2%),其中女性8例(66.7%)和男性4例(33.3%),包括有胸科手术患者5例、腹腔镜手术患者4例、颅内肿瘤手术患者2例、妇科手术患者1例.结论 术中知晓与性别、手术种类和ASA分级水平相关.     

全身麻醉患者术中知晓情况分析

目的:探讨目前全身麻醉方法行择期手术,术中知晓的发生率并分析可能引起术中知晓的原因。方法:回顾性分析全身麻醉的1 800例择期手术患者的临床资料,均采用硫喷妥钠、恩氟烷静吸复合全身麻醉。采用多元Logistic回归分析调查可能与术中知晓有关的因素进行分析。结果:1 800例患者中,发生肯定术中知晓的13例(0.72%)。结论:术中知晓可在多种择期手术中发生。     

全麻下患者术中知晓的临床分析

全麻的广泛应用，使得麻醉可控性大大提高。然而术中知晓未能完全避免，可能导致患者创伤后应激性精神障碍（PTSD）。本研究收集北京大学第一医院500例全身麻醉患者术中知晓发生情况，以期为术中知晓的防范提供资料。     

全麻术中知晓的发生率以及相关危险因素

目的:探究减少术中知晓发生率的途径,调查全麻术中知晓的发生率,并分析相关危险因素.方法:收集2 300例行全身麻醉的外科手术患者围手术期一般资料和麻醉药物用法用量,术后2次用标准化询问方式调查术中知晓的发生情况.所有患者分为3组:无知晓、可疑知晓和术中知晓.结果:肯定术中知晓的有21例(0.91%),术中可疑知晓的患者...     

全身麻醉手术中知晓发生率的调查与分析

目的对全身麻醉手术中知晓的发生情况进行调查与分析。方法选择2010年1月-2011年12月来我院择期予以手术的1856例患者为研究对象,均予以全身麻醉,记录术中知晓发生的详细情况,对其影响因素采用多因素Logistic回归分析。结果本组1856例患者共15例发生术中知晓,发生率为0．81％。术中知晓发生时期以维持期最多。占86．67％。不同科室中以妇科术中知晓发生率最高为2．03％,其次为耳鼻咽喉科为0．63％,再次为泌尿外科为0．54％。性别、年龄、是否使用阿片类镇痛剂、是否气管插管方式是影响术中知晓发生的危险因素,是否术前用药则是其保护因素。结论术中知晓好发于维持期,在多种择期手术者散发。为降低术巾知晓的发生率应注意女性患者,术前应充分用药,避免使用阿片类镇痛剂、行气管捕管。     

麻醉术中知晓发生率及其影响因素的研究进展

麻醉术中知晓是全麻过程中患者意识存在的标志,是一项严重的全身麻醉并发症,会对患者造成严重的心理和精神障碍,应该竭力避免。目前我国现代麻醉条件下全麻术中知晓的发生率还不明了,并且国内外对于麻醉术中知晓的影响因素一直尚未完全明确,这对麻醉医师采取有效的干预措施来避免或减少麻醉术中知晓造成了一定的困难,降低了麻醉的质量,增加了患者的和社会的负担。本文就此内容作一综述。     

全身麻醉患者术中知晓情况分析

目的探讨全身麻醉下患者术中知晓的发生情况并分析其相关危险因素。方法回顾性分析接受单纯全身麻醉的564例择期手术患者的临床资料,比较术中知晓发生与患者的年龄、性别、体质量、ASA分级、既往手术史、术中是否出现血压波动等指标的关系,采用多元Logistic回归分析术中知晓的高危因素。结果 564例患者发生术中知晓13例,术中知晓率为2.3%。女性、ASA评分、既往手术史及术中出现血压波动是患者发生术中知晓的高危因素(P<0.05)。结论在多种择期手术中术中知晓呈散发状态,女性、ASA分级水平、既往手术史、术中血压波动是其危险因素。     

Investigation and analysis of incidence of awareness in patients undergoing cardiac surgery in Beijing, China

Background Awareness under general anesthesia is a serious complication which leads to psychiatric disorders. The incidence of awareness in patients undergoing cardiac surgery has been reported in as many as 1.5%-23% in foreign countries. But so far, medical literature about awareness during cardiac surgery is still rare in China. Therefore, we investigated the incidence of awareness in patients undergoing different kinds of cardiac surgery, the phases when awareness occured and the effect of cardiopulmonary bypass on the incidence of awareness in coronary artery bypass grafting in Beijing. Methods Patients’ recall of awareness during cardiac surgery was assessed. One hundred patients undergoing coronary artery bypass grafting (CABG) in Chaoyang Hospital, Beijing, one hundred patients undergoing CABG and one hundred patients undergoing valve replacement or septal defect repair in Fuwai Hospital, Beijing, were interviewed 3-6 days after surgery. Every report obout patients on recall of awareness was recorded. An independent research team, blinded to patients’ surgery and anesthesia, assessed every report of awareness.Results The incidence of awareness of patients received CABG under cardiopulmonary bypass (CPB), off -pump CABG, septal repair or valve replacement under CPB was 4.7% (5 of 106 cases), 9.6% (9 of 94 cases) and 4% (4 of 100 cases), respectively. CPB did not greatly affect the incidence of awareness during the period of CABG (P&gt;0.05). The incidence of awareness of patients who received CABG under CPB did not increase significantly, in comparison with that of patients who received septal repair or valve replacement under CPB in Fuwai Hospital (P&gt;0.05). Awareness easily occurred before bypass grafting or CPB.Conclusions Awareness mainly occurs before bypass grafting or CPB in cardiac surgery. Most cases with awareness have auditory perceptions. CPB is not a main factor which affects the incidence of awareness of CABG. Surgical types do not affect the incidence of awareness of patients under CPB.     

妇科腹腔镜手术全身浅麻醉术中患者知晓率调查及其影响因素分析

目的调查在全身浅麻醉下行妇科附件良性肿瘤腹腔镜手术中患者的知晓率并分析其影响因素。方法随机选择900例在全身浅麻醉下行腹腔镜手术的妇科附件良性肿瘤患者,术后第1天及第2天调查患者有无术中知晓情况并统计知晓率,采用多元Logistic回归对相关影响因素进行分析。结果900例中有11例发生术中知晓,知晓率为1．22％。术中知晓的发生与年龄、术中低血压、过早停药、急诊手术等因素有关。结论妇科附件良性肿瘤腹腔镜手术全身浅麻醉知晓与年龄、术中低血压、过早停药、急诊手术等因素有关。预防术中知晓的根本措施在于合理监测麻醉深度。     

全凭静脉麻醉下脑电双频谱指数监测在术中知晓预防中的作用

目的:探讨全凭静脉麻醉下应用脑电双频谱指数(BIS)监测术中知晓的发生情况,评价BIS监测对术中知晓的预防作用.方法:丙泊酚全凭静脉麻醉下行择期手术患者300例,随机分成A、B两组(n=150).两组患者均进行BIS监测,A组根据BIS值调控麻醉深度,确保麻醉期间BIS值<60;B组术中遮蔽BIS值,根据经验调控麻醉深...     

Bispectral index monitoring prevent awareness during total intravenous anesthesia: a prospective, randomized, double-blinded, multi-center controlled trial

Background  Awareness is a serious complication of general anesthesia. In China, the incidence of intraoperative awareness was 1% in patients undergoing total intravenous anesthesia (TIVA). In this study, we compared the incidence of awareness between Bispectral index (BIS)-guided and routine TIVA protocol and evaluated the effect of BIS on preventing awareness.

Methods  A prospective, randomized, double-blinded, multicenter controlled trial was performed. Patients (≥18 years of age) undergoing TIVA were randomly divided into BIS-guided group (Group A, BIS was monitored and recommended to maintain between 40–60) and control group (Group B, BIS was monitored but the screen was covered). The intraoperative BIS values were downloaded and the BIS trends of confirmed awareness cases were analyzed to determine whether light anesthesia existed.

Results  Of the total 5228 patients, 2919 patients were assigned to Group A and 2309 to Group B. Four cases of confirmed awareness (0.14%) were reported in the BIS-guided group and 15 (0.65%) in the control group (P=0.002, OR=0.21, 95% confidence intervals: 0.07–0.63). The incidence of possible awareness (0.14% vs. 0.26%, P=0.485) and dreaming (3.1% vs. 3.1%, P=0.986) was comparable between BIS-guided group and the control group. Among the 19 confirmed awareness cases, intraoperative BIS trends of six cases were downloaded and identified. Five of them showed signs of light anesthesia as BIS >60 and lasted 19–106 minutes, whereas one case had a stable BIS trend and the values were within 60 during the operation. Another five awareness cases were reviewed for anesthesia procedures, of which improper light anesthesia were confirmed.

Conclusions BIS-guided TIVA (BIS was recommended to maintain between 40–60) decreased the risk of awareness compared with routine TIVA. The main reason for awareness was light anesthesia.

     

全身麻醉术中知晓的研究进展

全身麻醉术中出现的术中知晓,是一项严重全麻并发症。出现术中知晓的因素和机制很多。近年来,麻醉学家采取了各种措施预防和处理术中知晓,取得了一些进展。现就术中知晓产生机制、形成的相关因素、降低术中知晓发生率、监测及预防、如何开展对术中知晓的研究等作简要概述。     

全身麻醉下术中知晓情况的调查和分析

目的:调查全身麻醉技术下,术中知晓的发生率并分析其可能原因.方法:行全身麻醉的择期或急症外科手术病人1 800例,均未行脑电生理功能监测.术后第1天及第4天随访患者,调查术中知晓发生率.结果:1 800例患者中,发生肯定术中知晓的有13例(0.72%),术中做梦者145例(8.1%),145例患者中女性患者为108例(74.5%),接受异丙酚麻醉者114例(78.6%).结论:术中知晓与ASA分级水平相关,但与年龄、性别无关.而术中做梦的发生与年轻女性及异丙酚麻醉相关.     

心理卫生进社区对居民心理干预前后的比较研究

目的:探索心理卫生进社区对居民心理干预前后效果的比较研究。方法:建立一个有一定人口规模的社区做为研究基地。使用儿童行为量表(教师用)(RUTTER)、一般健康问卷(GHQ)、简易精神状态量表(MMSE)、上海市普通市民精神卫生知晓率调查问卷、精神卫生基础知识问卷(自编)来对社区居民进行施测。结果:社区居民经过心理干预后其知晓率比干预前有显著提高(P<0.01)。结论:心理卫生进社区对居民进行心理干预后可促进其对心理健康的关注。     

脑电双频指数监测值与术中知晓发生率关系的探讨

目的：分析脑电双频指数（BIS）监测值和术中发生知晓的关系。方法选取120例行全麻手术的患者,分为3组,试验组术中BIS值调控在40～60,对照1组在60～80,对照2组不行专门调控,比较3组BIS监测值,并对比术中知晓情况及术后苏醒时间。结果试验组术中BIS平均值为（51.7±6.3）,对照组1、2组分别（70.4±3.7）、（65.8±3.4）,组间比较有统计学意义（P＜0.05）。试验组无术中知晓患者,对照1组和对照2组均出现1例（2.5%）怀疑性知晓患者（P＜0.05）;3组术后睁眼、点头及对答持续时间差异无统计学意义。结论 BIS监测值和术中发生知晓有着一定相关性,BIS值在40～60时麻醉安全性高,临床可进行参照。