全身麻醉术中知晓的临床分析

目的：探讨新疆建设兵团“三甲”医院择期全身麻醉患者术中知晓的发生率及其相关影响因素。方法：采用前瞻性调查研究收集2012年3月至9月新疆建设兵团“三甲”医院1429例择期全麻手术患者，术后使用改良Brice调查表进行随访，调查术中知晓情况，参照Sandin等的方法将所有患者最终判定为无知晓，可疑知晓及知晓。结果：1429例患者中，11例（0．77％）发生术中知晓，39例（2．73％）判定为可疑知晓，其中24例（1．68％）诉做梦。采用Binarylogistic回归分析发现，咪唑安定、阿片类药物的使用及手术时间为术中知晓发生的影响因素（P〈0．05），而患者的性别、年龄、族别、肥胖指数、ASA分级、麻醉方法、手术类别、术中血压波动情况均与术中知晓的发生无关。结论：新疆建设兵团“三甲”医院术中知晓发生率为0．77％，在国内术中知晓发生率水平趋中；术前应用咪达唑仑及手术时间长是术中知晓发生的保护因素，而阿片类药物维持麻醉是术中知晓发生的危险因素。

Clinical Analysis of the Intraopertive Awareness During General Anesthesia

Objective： To investigate the incidence of awareness during general anesthesia and analyze the risk factor in anesthetic practice and patient populations. Methods： Acroding to inclusion and exclusion criteria, 1429 cases of patients with general anesthesia were enrolled between March 2012 to September in the grade A class 3 hospital in Xinjiang Production and Construction Corps（XPCC） .Patients were interviewed postoperatively with improved Brice questionnaire survey. Each patients was classified into categories as no awareness, possible awareness, and awareness. Results： Eleven patients （0.77%） definitely reported awareness, and 39 （2.73%）reported possible awareness. Another 24 （1.68%）had a dream. Midazolam,Opioids and time of operation were associated effect factors. Other factors were not related with the intraoperative awareness, they were gender,age, different nationality, BMI, ASA, type of anesthesia, types of surgery, and hemodynamic fluctuations. Conclusion： The rate of awareness in XPCC was 0.77%. It was similar to domestic intraoperative awareness level. Preoperative application of midazolam and long operation time were known in the protective factors, and opioid maintain anesthesia was risk factors.