丙泊酚静脉麻醉后患者的梦境回忆及影响因素

Dream recall of patients after intravenous propofol anesthesia and its influential factors

目的 研究丙泊酚静脉麻醉下梦境回忆的发生情况以及影响因素.方法 选择无痛苦胃镜或肠镜检查的非住院患者160例.静脉推注芬太尼和丙泊酚,待患者睫毛反射消失、OAA/S评分达0分开始进镜检查.检查结束后待患者OAA/S评分达5分后进行问卷调查.问卷调查内容包括改良Liker梦境内容评分量表、Brice标准提问以及患者检查前睡眠、精神状况等.结果 梦境回忆发生率为49.06%.较高的文化程度、恢复时间≤60 s、术前了解无痛检查、平常高梦境回忆频率是发生梦境回忆的独立预测因素（P〈0.05）.年龄、性别、ASA分级、检查部位、丙泊酚用量、检查时间、既往是否有无痛检查史、术前情绪状态、术前1月内失眠情况对梦境回忆的发生率无明显影响（P〉0.05）.结论 在丙泊酚镇静麻下实施内镜检查的患者,术后梦境回忆是一个常见的现象.此梦境的发生是一个神经生理一心理活动参与的过程,药物对中枢神经的药理作用起主导作用.

Objective To investigate the incidence of dream recall of patients after intravenous propofol anesthesia and its influential factors. Methods A total of 160 patients undergoing elective outpatient gastroscopy or colonoscopy were included in this study. Patients were anesthetized with intravenous propofol and fentanyl and endoscopic examination was started when eyelash reflex disappeared and Observer＇s Assessment of Alertness/Sedation （OAA/S） score was O. Questionnaire interview was conducted postoperatively when patients recovered from anesthesia and an OAA/S score of 5 was achieved. The questionnaire comprised the standard Brice questions, modified Liker scales, state of insomnia and emotion before the examination. Results Dream recall was reported in 49.06% of patients. Higher education level, recovery time shorter than 60 s, knowing of the painless examination before procedure and higher home dream recall were independent predictors of dream recall （P〈0.05）. Age, gender, ASA physical status,check sites, dosagee of propofol, examination time, previous history of painless examination, insomnia（within 1 month） and emotional states before procedure had no significant effects on dream recall （p〉0.05）. Conclusion Dream recall is a commom phenomenon in patients receiving anesthesia with propofol. This dream recall experience is a process involved in neurophysiology and psychology, and direct pharmacological effect on central nerve physiology has a predominant contribution.