强化麻醉前医患沟通与知情同意在防治椎管内麻醉神经并发症中的应用研究

Strengthening doctor-patient communication and informed consent before anesthesia for preventing and treating the neurological complications of intrathecal anesthesia:a research of the application

目的探讨强化麻醉前医患沟通与知情同意对椎管内麻醉神经并发症防治效果的影响。方法选取广西壮族自治区椎管内麻醉神经并发症发生总例数较多的前30家医院,并行椎管内麻醉下择期手术的17830例患者,随机分为对照组和观察组。对照组常规麻醉前访视并签署通用的麻醉知情同意书;观察组在对照组基础上采用多种方式强化麻醉前医患沟通与麻醉知情同意。采用Zung自评焦虑量表(SAS)评估患者术前1天即麻醉前访视(T0)、进入手术室实施麻醉前(T1)及术后第1天(T2)焦虑状态,采用自制量表评估患者麻醉依从性,记录患者发现神经并发症症状时间和确诊时间、并发症发生情况,以及麻醉满意度。结果与对照组比较,观察组患者T1和T2时点的SAS评分较低,发现神经并发症症状时间及确诊时间较早,神经并发症发生率较低,麻醉依从性及患者满意度较高(均P<0.05)。结论强化麻醉前医患沟通与麻醉知情同意可减轻患者焦虑,降低椎管内麻醉神经并发症发生率,利于及早诊断和治疗椎管内麻醉的神经并发症,提高患者对麻醉的依从性及满意度。

Objective To investigate the effect of strengthening doctor-patient communication and informed consent before anesthesia for preventing and treating the neurological complications of intrathecal anesthesia.Methods The top 30 hospitals in Guangxi Zhuang Autonomous Region with more cases of neurological complications of intrathecal anesthesia,and a total of 17830 patients underwent elective operation of intrathecal anesthesia were enrolled,and they were randomly assigned into control group and observation group.Routine pre-anesthesia visit was conducted and general informed consent for anesthesia was signed in the control group,based on which various methods of strengthening doctor-patient communication and informed consent for anesthesia were employed before anesthesia in the observation group.The Zung Self-rating Anxiety Scale(SAS)was employed to evaluate the anxiety state on the day before operation,namely visit before anesthesia(T0),and the anxiety state of entering the operation room before conducting anesthesia(T1),as well as the anxiety state on the first day after operation(T2).Self-made scale was used to evaluate anesthesia compliance in patients;furthermore,the duration of neurological complications symptoms and confirmed time,the prevalence of complications,and anesthesia satisfaction were record in patients.Results Compared with the control group,the patients in the observation group obtained lower scores in T1 and T2,earlier time of perceiving neurological complications symptoms and confirmation,lower incidence of neurological complications,and higher anesthesia compliance and satisfaction of patients(all P<0.05).Conclusion Strengthening doctor-patient communication and informed consent for anesthesia before anesthesia can alleviate anxiety of patients,decrease the incidence of neurological complications of intrathecal anesthesia.It is helpful to diagnose and treat neurological complications of intrathecal anesthesia as soon as possible,and to increase anesthesia compliance and satisfaction of patients.