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全麻患者对麻醉满意度不高的相关因素临床分析
Clinical analysis of the correlative factors in patient dissatisfaction after general anesthesia
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DOI:
作者:
陈易,魏月侠,王志华,倪新莉
Chen Yi, Wei Yuexia, Wang Zhihua, Ni Xinli
作者单位:
宁夏医科大学总医院麻醉科
Department of Anesthesiology, General Hospital of Ningxia Medical University
关键词:
全身麻醉;麻醉满意度;相关因素
General anesthesia; Patient satisfaction; Correlative factors
摘要:
目的 采用术后恢复质量量表(Postoperative Quality Recovery Scale, PQRS)分析全麻术后患者麻醉满意度的影响因素。方法 选择择期全麻下行非心脑手术成年患者369例,于术后24h、72h和168h对患者的麻醉满意度进行调查并同时进行PQRS评估。患者满意度分为完全满意、一般、不太满意和非常不满意。任意时间点均选完全满意者纳入满意组,选择其余三项之一者纳入不满意组。对与患者不满意相关指标进行单因素分析及Logistic多因素非条件回归分析。结果 入选患者89.97%(332例)表示对麻醉完全满意。多因素Logistic回归分析显示,引起全麻患者不满意的原因从主到次依次为术后恶心呕吐(OR=4.82,CI=1.85-12.59)、术前焦虑(OR=3.79,CI=1.60-8.94)、术后持续疼痛(72h:OR=3.59,CI=1.30-9.93;24h:OR=3.38,CI=1.42-8.03)、术后认知能力减退(OR=2.84,CI=1.31-6.18)以及麻醉持续时间延长(OR=1.79,CI=1.06-3.04)。结论 PQRS分析提示,引起全麻患者不满意的最主要原因是术后恶心呕吐,其次是术后疼痛、术前焦虑、麻醉时间长以及术后一周内认知仍不能完全恢复。
Objective To analyze the influencing factors of patient dissatisfaction after general anesthesia with the use of Postoperative Quality Recovery Scale (PQRS). Methods A total of 369 patients undergoing non cardiac or brain surgery were enrolled. All subjects were assessed by PQRS on their patient satisfaction with anesthesia and associated indicators with recovery at 24h, 72h, 168h after extubation. A four-point scale was used with satisfaction responses: totally satisfied; moderately satisfied; not very satisfied; or not at all satisfied. Patients choosed ‘totally satisfied’ at any point in time was divided into the completely satisfied group, others were divided into the not completely satisfied group. Univariate analysis was performed to those relative factors with patient dissatisfaction, and sieved meaningful measures to carry on multivariate non-conditional logistic regression analysis. Results Total satisfaction occurred in 332 patients with the incidence of 89.97%. Logistic regression analysis results indicated that the risk factors of patient dissatisfaction from high to low were nausea and vomiting at day1 (OR=4.82,CI=1.85-12.59) after extubation, preoperative anxiety (OR=3.79,CI=1.60-8.94), constant pain (72h:OR=3.59,CI=1.30-9.93; 24h:OR=3.38, CI=1.42-8.03), postoperative unrecovered cognitive function (OR=2.84, CI=1.31-6.18) at day 7 after extubation and increased duration of anesthesia (OR=1.79,CI=1.06-3.04). Conclusion Combine clinical comprehensive results of PQRS with statistical analysis to get a conclusion, the primary cause of patient dissatisfaction after general anesthesia were nausea and vomiting. Other causes included nociceptive pain, preoperative anxiety, increased duration of anesthesia and unrecovered cognitive function within one week.
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