Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.
Anesth Analg. 2010 Mar 1;110(3):823-8. doi: 10.1213/ANE.0b013e3181b8b6ca. Epub 2009 Oct 27.
The long-term consequences of an awareness episode vary. Some patients do not have any long-term disability, whereas others develop psychological problems that may be severe and persistent. In this study, we compared the incidence of posttraumatic stress disorder (PTSD) in patients with and without confirmed awareness who were randomized in the B-Aware Trial.
We used a matched cohort design, aiming to follow up the 13 patients with confirmed awareness. Each surviving awareness patient was matched with 4 controls for age, sex, surgery type, date of surgery, and hospital. A face-to-face interview was conducted with each awareness patient and matched controls using the Clinician Administered Posttraumatic Stress Disorder Scale.
Data collection for this study occurred between June 2006 and March 2007, with a median follow-up time of 5.3 yr (range, 4.3-5.7 yr). Six of the 13 confirmed awareness patients had died. Five of the 7 confirmed awareness patients (71%) and 3 of the 25 controls (12%) fulfilled the criteria for PTSD at the time of the interview (adjusted odds ratio = 13.3 [95% confidence interval: 1.4-650]; P = 0.02). The median onset time of symptoms was 14 days (range, 7-243 days) after surgery, and the median duration of symptoms was 4.7 yr (range, 4.4-5.6 yr).
PTSD was common and persistent in the confirmed awareness patients of the B-Aware Trial. Strategies to prevent awareness in patients under general anesthesia are justified.
意识事件的长期后果各不相同。有些患者没有任何长期残疾，而有些患者则会出现严重且持久的心理问题。在这项研究中，我们比较了 B-Aware 试验中随机分组的有明确意识和无明确意识患者发生创伤后应激障碍（PTSD）的发生率。
我们采用了匹配队列设计，旨在对 13 名有明确意识的患者进行随访。每例存活的有意识患者都与 4 名年龄、性别、手术类型、手术日期和医院相匹配的对照进行匹配。对每位有意识患者和匹配的对照进行面对面访谈，使用 Clinician Administered Posttraumatic Stress Disorder Scale 进行评估。
本研究的数据收集时间为 2006 年 6 月至 2007 年 3 月，中位随访时间为 5.3 年（范围，4.3-5.7 年）。13 名有明确意识的患者中有 6 人死亡。在接受访谈时，7 名有明确意识的患者中有 5 名（71%）和 25 名对照中有 3 名（12%）符合 PTSD 的标准（调整后的优势比=13.3[95%置信区间：1.4-650]；P=0.02）。症状的中位发病时间为手术后 14 天（范围，7-243 天），症状的中位持续时间为 4.7 年（范围，4.4-5.6 年）。
B-Aware 试验中明确意识的患者 PTSD 很常见且持续存在。对全麻患者预防意识的策略是合理的。
