Block R I, Ghoneim M M, Sum Ping S T, Ali M A
Department of Anesthesia, University of Iowa, Iowa City 52242.
Anesthesiology. 1991 Nov;75(5):746-55. doi: 10.1097/00000542-199111000-00005.
There have been claims that the postoperative course of patients may be improved by presentation during general anesthesia of therapeutic suggestions which predict a rapid and comfortable postoperative recovery. This study evaluated the effectiveness of such therapeutic suggestions under double-blind and randomized conditions. A tape recording predicting a smooth recovery during a short postoperative stay without pain, nausea, or vomiting was played during anesthesia to about half the patients (N = 109), while the remaining, control patients were played a blank tape instead (N = 100). The patients were primarily undergoing operations on the fallopian tubes, total abdominal hysterectomy, vertical banding gastroplasty, cholecystectomy, and ovarian cystectomy or myomectomy. The anesthesia methods consisted of either isoflurane with 70% nitrous oxide in oxygen to produce end-tidal concentrations of 1.0, 1.3, or 1.5 MAC; or 70% nitrous oxide in oxygen combined with high or low doses of opioids. Assessments of the efficacy of the therapeutic suggestions in the recovery room and throughout the postoperative hospital stay included: the frequency of administration of analgesic and antiemetic drugs; opioid doses; the incidence of fever; nausea, retching, and vomiting; other gastrointestinal and urinary symptoms; ratings of pain; ratings of anxiety; global ratings of the patients' physical and psychological recoveries by the patients and their nurses; and length of postoperative hospital stay. There were no meaningful, significant differences in postoperative recovery of patients receiving therapeutic suggestions and controls. These negative results were not likely to be due to insensitivity of the assessments of recovery, as they showed meaningful interrelations among themselves and numerous differences in recovery following different types of surgery. Widespread utilization of therapeutic suggestions as a routine operating room procedure seems premature in the absence of adequate replication of previously published positive studies.
有人声称，在全身麻醉期间提出预测术后快速且舒适恢复的治疗建议，可能会改善患者的术后病程。本研究在双盲和随机条件下评估了此类治疗建议的有效性。在麻醉期间，向大约一半的患者（N = 109）播放了一段预测术后短期内顺利恢复且无疼痛、恶心或呕吐的录音带，而其余作为对照的患者则播放了一段空白录音带（N = 100）。这些患者主要接受输卵管手术、全腹子宫切除术、垂直捆绑胃成形术、胆囊切除术以及卵巢囊肿切除术或子宫肌瘤切除术。麻醉方法包括：使用异氟烷与70%氧化亚氮混合于氧气中，以使呼气末浓度达到1.0、1.3或1.5 MAC；或者70%氧化亚氮混合于氧气中并联合高剂量或低剂量阿片类药物。在恢复室以及整个术后住院期间，对治疗建议效果的评估包括：镇痛和止吐药物的使用频率；阿片类药物剂量；发热发生率；恶心、干呕和呕吐情况；其他胃肠道和泌尿系统症状；疼痛评分；焦虑评分；患者及其护士对患者身体和心理恢复情况的总体评分；以及术后住院时间。接受治疗建议的患者与对照组患者在术后恢复方面没有显著的有意义差异。这些负面结果不太可能是由于恢复评估不敏感所致，因为这些评估之间显示出有意义的相互关系，并且不同类型手术之后的恢复情况存在众多差异。在缺乏对先前发表的阳性研究进行充分重复验证的情况下，将治疗建议作为常规手术室操作广泛应用似乎还为时过早。
