不同麻醉深度指数下右美托咪定对腰硬联合麻醉患者内隐记忆和外显记忆的影响  

The Effects of Dexmedetomidine on Implicit and Explicit Memory in Patients with Combined Spinal-epidural Anesthesia under Different Cerebral State Index

作　　者：王启明 韦信洪 石俊丹 吴真俊 甘立书 陆健君 董丽露 罗成 WANG Qi-ming;WEI Xin-hong;SHI Jun-dan;WU Zhen-jun;GAN Li-shu;LU Jian-jun;DONG Li-lu;LUO Cheng(The First Affiliated Hospital of Guangxi University of Chinese Medicine,Nanning,Guangxi,530023)

机构地区：[1]广西中医药大学第一附属医院,广西南宁530023

出　　处：《广西中医药大学学报》2024年第4期19-23,共5页Journal of Guangxi University Of Chinese Medicine

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(编号:Z20211333)。

摘　　要：[目的]观察不同麻醉深度指数(CSI)下右美托咪定对腰硬联合麻醉患者内隐记忆和外显记忆的影响。[方法]选取行腰硬联合麻醉的择期手术患者80例,按随机数字表法分为两组,即D1组(CSI>60~80)和D2组(CSI为40~60)各40例。所有患者均行腰硬联合麻醉,待麻醉起效、符合手术要求后进行听词学习:在泵注盐酸右美托咪定注射液前给予清醒听词学习;在持续泵注盐酸右美托咪定注射液达到设定麻醉深度指数后,予镇静听词学习。记录泵注盐酸右美托咪定注射液前(T_(0))、泵注盐酸右美托咪定注射液达到设定麻醉深度指数时(T_(1))、患者麻醉深度指数恢复至90时(T_(2))的平均动脉压(MAP)、心率(HR)、血氧饱和度(Sp O_(2))数值。两组患者于T_(2)后6 h进行记忆测试。[结果]两组患者T_(1)时间点的MAP、HR与同组T_(0)时间点比较,均明显降低,差异有统计学意义(P<0.05);同组各时间点Sp O_(2)比较无显著性差异(P>0.05)。在T_(1)时间点,D2组患者MAP、HR较D1组低,差异有统计学意义(P<0.05);两组Sp O_(2)比较差异无统计学意义(P>0.05)。D1组内隐记忆成绩为[0.09(0.03,0.15)]分,与0分(无记忆分值)比较,差异有统计学意义(P<0.05);外显记忆成绩为[0.03(0.00,0.10)]分,与0分比较,差异无统计学意义(P>0.05);D2组内隐记忆成绩为[0.02(-0.03,0.11)]分,外显记忆成绩为[0.01(-0.01,0.13)]分,与0分比较,差异均无统计学意义(P>0.05)。[结论]右美托咪定可抑制CSI>60~80的腰硬联合麻醉手术患者外显记忆形成,但不能避免内隐记忆形成;可抑制CSI为40~60的腰硬联合麻醉手术患者内隐记忆和外显记忆形成。[Objective]To investigate the effects of dexmedetomidine on implicit and explicit memory in patients with combined spinal-epidural anesthesia under different cerebral state index(CSI).[Methods]A total of 80 patients who planned to applied combined spinal-epidural anesthesia were randomly divided into D1 group(CSI>60~80)and D2 group(CSI 40~60)by random number table method,with 40 patients in each group.All the patients were applied combined spinal-epidural anesthesia,auditory stimulus were presented when the anesthesia took effect and met surgical requirements.The first stimulus was presented when the patients were awake before pumping dexmedetomidine hydrochloride.The second auditory stimulus was presented when reached to set CSI after pumping dexmedetomidine hydrochloride.MAP、HR and Sp O_(2)were recorded before pumping dexmedetomidine hydrochloride(T_(0)),when CSI reaches the set level after pumping(T_(1)),and CSI recovered to 90(T_(2)).6 hours after T_(2),memory test were conducted.[Results]At T_(1),MAP and HR of both groups of patients were significantly lower compared to those at T_(0),with statistical significance(P<0.05).There was no significant difference in Sp O_(2)among the same time points for the two groups(P>0.05).At T_(1),MAP and HR of D2 group were significantly lower than those of D1 group(P<0.05);there was no significant difference in Sp O_(2)between these two groups(P>0.05).In D1 group,the difference between the implicit memory score[0.09(0.03,0.15)]and zero(score of no memory)was significant(P<0.05),while the difference between the explicit memory score[0.03(0.00,0.10)]and zero was not(P>0.05).In group D2,there was no statistical difference between the implicit memory score[0.02(-0.03,0.11)]and zero,so as the explicit memory score[0.01(-0.01,0.13)](P>0.05).[Conclusion]Dexmedetomidine can inhibit the formation of explicit memory in patient with combined spinal-epidural anesthesia under CSI>60~80,while can not inhibit the formation of implicit memory.It can inhibit the formation of both implicit

关 键 词：右美托咪定 麻醉深度指数 内隐记忆 外显记忆 加工分离程序 

分 类 号：R614.3[医药卫生—麻醉学]