Samuelsson Peter, Brudin Lars, Sandin Rolf H
Department of Anesthesiology, County Hospital, Kalmar, and Medicine and Care, Faculty of Health Sciences, Linköping University, Sweden.
Anesthesiology. 2007 Jan;106(1):26-32. doi: 10.1097/00000542-200701000-00009.
Awareness during general anesthesia can cause late psychological symptoms. Selection bias may have affected the results in previous retrospective studies. The authors used prospective consecutive collection to recruit patients with previous awareness.
In a cohort of 2,681 consecutive patients scheduled to undergo general anesthesia, 98 considered themselves to have been aware during previous surgery. Six patients died before inclusion, and another 13 were excluded (4 cases of stroke or dementia, 7 declined to participate, and 2 could not be located). Seventy-nine patients were interviewed by telephone, and medical records were checked in uncertain cases. The interview followed a structured protocol, including seven late symptoms (anxiety, chronic fear, nightmares, flashbacks, indifference, loneliness, and lack of confidence in future life). Three persons independently assessed the interviews for classification, to determine whether awareness had occurred.
Four cases were performed using regional anesthesia, and another 29 were not considered as awareness by the assessors. Therefore, the final analyses included 46 patients. Twenty (43%) had experienced pain, and 30 (65%) described acute emotional reactions during the awareness episode. Fifteen (33%) patients had experienced late psychological symptoms afterward. In 6 of those cases, the symptoms lasted for more than 2 months, and 1 patient had a diagnosis of post-traumatic stress disorder. Acute emotional reactions were significantly related to late psychological symptoms (P<0.05).
The method for recruiting awareness cases in studies on late psychological symptoms may affect the result. The authors found fewer and milder problems, despite a similar degree of initial problems as in previous studies.
全身麻醉期间的知晓可能会导致后期心理症状。选择偏倚可能影响了以往回顾性研究的结果。作者采用前瞻性连续收集的方法招募有过知晓经历的患者。
在一组连续2681例计划接受全身麻醉的患者中，98例认为自己在之前的手术中有过知晓经历。6例患者在纳入研究前死亡，另有13例被排除（4例中风或痴呆，7例拒绝参与，2例无法找到）。79例患者接受了电话访谈，对情况不确定的病例检查了医疗记录。访谈遵循结构化方案，包括七种后期症状（焦虑、慢性恐惧、噩梦、闪回、冷漠、孤独以及对未来生活缺乏信心）。三人独立评估访谈结果以进行分类，确定是否发生了知晓。
4例采用区域麻醉，另有29例被评估者认为不属于知晓情况。因此，最终分析纳入46例患者。20例（43%）经历过疼痛，30例（65%）描述了知晓期间的急性情绪反应。15例（33%）患者随后出现了后期心理症状。其中6例症状持续超过2个月，1例被诊断为创伤后应激障碍。急性情绪反应与后期心理症状显著相关（P<0.05）。
研究后期心理症状时招募知晓病例的方法可能会影响结果。尽管初始问题程度与以往研究相似，但作者发现问题较少且较轻。
