全身麻醉下知晓发生率及其影响因素分析

目的]探讨全身麻醉下的知晓发生率,并对其影响因素进行筛选,确定保护因素与危险因素.方法]选择自2008年5月到2010年12月间在不同科室接受治疗的1 504例患者作为研究对象,均行单纯性全身麻醉.记录患者手术过程中的各类影响因素情况,分别为性别、年龄、体重、是否使用阿片类镇痛剂、是否使用挥发性麻醉剂、是否气管插管方式、是否术前用药、手术过程中血压变化、麻醉时间和ASA分级.按照不同的科室分为骨科、普通外科、心胸外科、神经外科、整形外科、泌尿外科及其他科室,对知晓情况进行调查.结果]不同科室中知晓发生率最高的科室为心胸外科,为1.00%,其次为普通外科和神经外科,知晓发生率均为0.08%.多因素逐步Logistic回归分析结果示,有影响的因素为性别、年龄、是否使用阿片类镇痛剂、是否气管插管方式和是否术前用药,其中危险因素为性别、年龄、是否使用阿片类镇痛剂及是否气管插管方式,保护因素为是否术前用药.结论]全身麻醉下知晓发生率较低,但应注意高年龄段女性人群的危险性,并充分术前用药,避免使用阿片类镇痛剂和行气管插管,以确保手术麻醉的质量.

Analysis of the rate of awareness and its influencing factors during general anesthesia

OBJECTIVE To explore the rate of awareness during general anesthesia,and to analyse the influencing factors and set the guard and risk factors.METHODS Select 1 504 cases who were examined in different departments from May 2008 to December 2010 as the research object.All the cases should take simple general anesthesia,record the influencing factors during the operation process.The factors included gender,age,weight,using opioid medicine or not,using voiatile anesthesia or not,style of orotracheal intubation,premedicate or not,blood pressure variation,anesthesia time and ASA grade.The patients were separated into groups according to different departments,including orthopedics,general surgery,cardiovascular surgery,neurosurger,orthopedic surgery,urological surgery and the other departments.RESULTS The highest awareness rate group is cardiovascular surgery department,to be 1.00%,and general surgery department and neurosurger department were 0.08%.Multiple regression analysis showed that the influencing factors included gender,age,using opioid medicine or not,style of orotracheal intubation and premedicate or not.The risk factors included gender,age,using opioid medicine or not and style of orotracheal intubation,and the guard factor was premedicate or not.CONCLUSION The rate of awareness was lower during general anesthesia,but more attention should be paid on females with old age.They should take medicine before operation and avoid using opioid medicine and orotracheal intubation in order to improve the quality of anesthesia operation.