非心脏手术全麻患者术中知晓发生情况的调查与分析

Investigation and analysis of the incidence of intraoperative awareness during general anesthesia in non-cardiac surgery

目的调查非心脏手术全麻患者术中知晓的发生率，分析其发生的可能原因和相关因素，探讨预防术中知晓的策略。方法随机选择非心脏手术全麻患者1000例，美国麻醉医师协会（ASA）分级Ⅰ—Ⅴ级，年龄16岁～84岁，均未予神经电生理监测。术后第1天和第3天随访患者，调查全麻术中知晓的发生情况，采用Mashour分级方法对患者术中知晓进行分级。结果1000例患者中，发生术中知晓者16例（1．6％），其中Mashour3级以上（含3级）者12例。静吸复合维持麻醉患者术中知晓发生率为0．7％，而全凭静脉恒速给药方式输注丙泊酚维持麻醉患者术中知晓率高达5．1％（P〈0．05）。术中知晓多发生在妇科腹腔镜手术，同时可散发于多种择期手术中。女性（OR=5．262）和术中血压下降（OR=5．324）是全身麻醉患者术中知晓的可能相关因素，而吸入麻醉维持（OR=0．168）是其可能保护因素。结论与静吸复合麻醉比较，全凭恒速给药方式输注丙泊酚维持麻醉患者术中知晓发生率较高，应当引起重视。

Objective To investigate the incidence of intraoperative awareness during general anesthesia and analyze the risk factors, in order to find the measures for prevention of intraoperative awareness. Methods One thousand ASA Ⅰ-Ⅴ patients aged 16-84, undergoing non-cardiac surgery and general anesthesia were randomly enrolled. Additional neurophysiologieal monitoring was not allowed in any patient. Interviews were conducted in 24 h and 72 h postoperatively to survey the incidence of awareness during operation. Each patient was classified according to Mashour＇s classification. Results Of all the patients, 16 （ 1.6% ） patients reported awareness, twelve patients were classified into Mashour＇s classification 3-5. The incidence of intraoperative awareness was 0.7% in patients undergoing intravenous-inhalation combined anesthesia and 5.1% in patients undergoing total intravenous anesthesia by constant infusion of propofol during operation （P〈0.05）. Awareness can be occurred in a variety of surgeries, while the incidence of awareness was higher in patients undergoing gynecological laparoscopic surgery than others. Being female （OR =5.262） and intraoperative hypotension （OR =5.324） are the possible risk factors of intraoperative awareness. Maintenance of anesthesia with inhalation anesthetics （0R=0.168） is the possible protective factor of avoidance of awareness. Conclusions Compared with intravenousinhalation combined anesthesia, the incidence of intraoperative was higher in patients undergoing total intravenous anesthesia by constant infusion of propofol during operation.