剖宫产术全身麻醉过程中麻醉深度变化、术中外显记忆及内隐记忆存在情况研究  

Study on the changes of anesthesia depth and the presence of explicit and implicit memory during general anesthesia in Cesarean section

作　　者：欧英余 杨丽杰 崔宇 郭浪涛 黎举红[2] 曹蓉 OU Ying-yu;Yang Li-jie;CUI Yu;GUO Lang-tao;LI Ju-hong;CAO Rong(Department of Anesthesiology,Chengdu Women's and Children’s Central Hospital,Affiliated Women’s and Children’s Hospital,School of Medicine,University of Electronic Science and Technology of China,Chengdu 610091,China;Department of Psychiatry,Chengdu Mental Health Center,Chengdu 610036,China)

机构地区：[1]电子科技大学医学院附属妇女儿童医院,成都市妇女儿童中心医院麻醉科,四川成都610091 [2]成都市精神卫生中心精神科,四川成都610036

出　　处：《临床军医杂志》2021年第8期887-889,共3页Clinical Journal of Medical Officers

基　　金：四川省医卫计委科研项目(16PJ073);成都市卫生局科研课题(2014019)。

摘　　要：目的探讨丙泊酚联合瑞芬太尼在剖宫产术全身麻醉过程中麻醉深度的变化、术中外显记忆及内隐记忆存在情况。方法将电子科技大学医学院附属妇女儿童医院自2018年3月至2019年12月收治的40例全身麻醉行剖宫产手术患者纳入观察组(G组),另将80例同期在腰硬联合麻醉清醒状态下行剖宫产术产妇随机分入E1组、E2组,每组各40例。G组、E1组产妇术中、术后播放2次录音,E2组仅在术后6 h播放1次录音。麻醉诱导采用顺序静推丙泊酚2.0 mg/kg,瑞芬太尼1.0μg/kg,司可林1.5 mg/kg。给药5 min后,如果胎儿未娩出,追加丙泊酚50.0 mg,瑞芬太尼50.0μg。胎儿娩出后,采用舒芬太尼与丙泊酚维持麻醉。记录并比较3组产妇一般资料及新生儿Apgar评分。记录G组娩出前各时间点[诱导后插管前最低点(T_(1))、气管插管后(T_(2))、插管刺激消除过后(T_(3))、给药后5 min(T_(4))、给予少量追加药后(T5)]的脑电意识指数(IoC1)、伤害敏感指数(IoC2)及术中外显记忆情况。比较3组产妇模糊辨听命中数。结果G组产妇T_(2)、T_(4)时的IoC1值均高于T_(1)时,差异均有统计学意义(P<0.05)。G组产妇T_(2)、T_(4)时的IoC2值均高于T_(1)时,T5时的IoC2值低于T_(1)时,差异均有统计学意义(P<0.05)。G组、E1组产妇模糊辨听命中数分别为(8.68±1.97)个、(8.90±1.91)个,均高于E2组的(7.33±2.09)个,差异均有统计学意义(P<0.05)。结论丙泊酚联合瑞芬太尼的麻醉方案能够消除外显记忆,但诱导阶段可能存在内隐记忆。Objective To investigate the effect of propofol combined with remifentanil on the depth of anesthesia and the presence of explicit and implicit memory during cesarean section.Methods Forty patients undergoing cesarean section under general anesthesia admitted to Women′s and Children′s Hospital affiliated to The School of Medicine of University of Electronic Science and Technology of China from March 2018 to December 2019 were included in the observation group(Group G),and another 80 women undergoing cesarean section under combined lumbar epidural anesthesia during the same period were selected as group E1 and group E2,with 40 cases in each group.Group G and E1 played two recordings during and after labor,and group E2 only played one recording at 6 h after labor.Anesthesia induction was performed with sequential intravenous propofol 2.0 mg/kg,remifentanil 1.0μg/kg,and serrin 1.5 mg/kg.5 minutes after administration,if the fetus is not delivered,add propofol 50.0 mg and remifentanil 50.0μg.After delivery,sufentanil and propofol were used to maintain anesthesia.The general information and Apgar score of the 3 groups were recorded and compared.The eeg awareness index(IoC1),injury sensitivity index(IoC2)and explicit memory of group G were recorded at each time point[the lowest point before intubation after induction(T_(1)),after endotracheal intubation(T_(2)),after elimination of intubation stimulation(T_(3)),5 minutes after administration(T_(4)),and after a small amount of additional drugs(T5)]before childbirth.The median number of the three groups was compared.Results IoC1 values in group G at T_(2) and T_(4) were higher than those at T_(1),and the differences were statistically significant(P<0.05).The IoC2 values at T_(2) and T_(4) were higher than those at T_(1),and the IoC2 values at T5 were lower than those at T_(1),with statistical significance(P<0.05).The median number of fuzzy hearing in G group and E1 group was(8.68±1.97)and(8.90±1.91),higher than that in E2 group(7.33±2.09),with statistical signifi

关 键 词：全身麻醉 剖宫产 内隐记忆 脑电意识指数 伤害敏感指数 外显记忆 

分 类 号：R614.2[医药卫生—麻醉学]