麻醉手术期间的知晓-165例普鲁卡因静脉复合麻醉的临床调查

Awareness during Surgical Anaesthesia-A clinical Investigation into 165 surgical Patients after Procaine Balanced Anaesthesia

采用术后询问,对165例普鲁卡因-氧-芬太尼-琥珀酰胆碱复合麻醉手术后病人的知晓进行调查。其中9.7％(16/165)患者诉对以下一项或一项以上事件知晓;气管插管、切皮、手术操作及术者交谈;对知晓的描述可为无痛、可耐受、痛、痛甚、痛极不可耐受。在四例病人发现程度不同的创伤性精神症状,表现为紧张焦虑、失眠、不愿谈及术中经历。统计分析表明:与无知晓病例相比,知晓病例明显较年轻且麻醉时间长(分别 P<0.01)。年龄小于40岁及手术时间长达250min 及以上者知晓比例增加(分别 P<0.05)。14.55％(24/165)病例诉术终对缝针和/或气管导管知晓。这些病例较无知晓者年轻(P<0.05),以女性病例占多数(P<0.001)。术中知晓的原因可能为相对麻醉深度不够,病人痛阈及其他阈值的个体差异。

An investigation by interviewing postoperative patients(165 cases) was made into awareness during surgery under pro-caine-fentanyl-oxygen-suxamethonium balanced anaesthesia.Of the patients interviewed,9.7%(16/165) claimed awarenessof one or more of the following events during operation:intubation,skin incision,surgical procedure,and surgeon's conversa-tion;the description of awareness could be unpainful and tolerable,or painful,or very painful,of terriblly painful and intolerable.Postoperative traumatic neurosis was found,more or less,in 4 cases featuring anxiety and irritability,insomnia,and reluc-tance to talk about their awareness.Nevertheless,awareness was not always miserable.Statistical analysis revealed that,in com-parison with unawareness cases,awareness cases were much younger(P<0.01),and their duration of anaesthesia was mnchlonger(P<0.01).Those who were under 40-yr-old,and those whose anadsthesia lasted up to 250 min or longer were mostprone to awareness(P<0.05,respectively).About 14.55%(24/156)cases claimed awareness at surgery\ending of stitchesand/or tracheal tube,some of them experienced pain.These cases were younger than unawareness cases(P<0.05),and domi-nated by female(P<0.001).The causes of surgical awareness were thought to be relatively inadequate anaesthesia and per-sonal variations in pain threahold,and other thresholds.Some implications of the complication are discussed on the purpose toimprove perioperative patient care.