择期全麻手术患者术中知晓影响因素分析  

Incidence and influence factors of accidental awareness during general anesthesia in selective operation

作　　者：赵冰晓 艾艳秋[1] 金峰[1] 何龙[1] 李达[1] 张舒驰[1] 

机构地区：[1]郑州大学第一附属医院麻醉科,450052

出　　处：《临床麻醉学杂志》2016年第6期547-549,共3页Journal of Clinical Anesthesiology

摘　　要：目的回顾性分析择期手术接受全身麻醉患者术中知晓情况,探讨术中知晓的影响因素。方法收集2013年4月至2015年7月在郑州大学第一附属医院行择期手术接受全身麻醉的患者,记录患者年龄、性别、体重、ASA分级、人工气道建立情况、麻醉药物和血管活性药物使用及术后随访情况,明确术中知晓发生率,并应用多因素Logistic回归分析全身麻醉下术中知晓的影响因素。结果共纳入全身麻醉患者141 294例,其中有80例（0.06%）发生术中知晓。术中知晓的危险因素为全凭静脉麻醉（OR=5.181,95%CI 3.032~8.853）、喉罩通气（OR=2.478,95%CI 1.544~3.977）和ASAⅢ或Ⅳ级（OR=9.202,95%CI 5.475~15.466）。术前应用咪达唑仑（OR=0.125,95%CI 0.080~0.196）、术中复合吸入七氟醚（OR=0.193,95%CI 0.113~0.330）有助于降低术中知晓的发生率。结论全凭静脉麻醉、喉罩通气、ASAⅢ或Ⅳ级是全身麻醉患者术中知晓的危险因素,术前应用咪达唑仑、术中复合吸入七氟醚可降低术中知晓的发生率。Objective To retrospectively investigate the incidence of accidental awareness during general anesthesia in selective operation and analyze the influence factors of accidental aware-ness.Methods Patients scheduled for elective surgery requiring general anesthesia with artificial air-way during April 2013-July 2015 were collected.The incidence was obtained from postoperative fol-low-ups.Perioperative data and anesthetic drugs were collected to analyze influence factors. Results A total of 141 294 patients were enrolled.Eighty patients （0.06%）were definitely identified as awareness.Multiple regression analysis showed that awareness during operation was associated with total intravenous anesthesia （OR=5.181,95% CI 3.032-8.853）,using laryngeal mask airway （OR=2.478,95% CI 1.544-3.977）and ASA Ⅲ or Ⅳ （OR=9.202,95% CI 5.475-15.466）.Pre-medication of midazolam （OR=0.125,95% CI 0.080-0.196）and combination of sevoflurane （OR=0.193,95% CI 0.113-0.330）had lower incidence of awareness during operation.Conclusion Total intravenous anesthesia,using laryngeal mask airway and ASA Ⅲ or Ⅳ are risk factors of accidental awareness during general anesthesia.Premedication of midazolam and combination of sevoflurane may prevent awareness during operation.

关 键 词：全身麻醉 术中知晓 影响因素 

分 类 号：R614.2[医药卫生—麻醉学]