瑞马唑仑全凭静脉麻醉下外显记忆和内隐记忆的评估

Assessment of explicit and implicit memory under total intravenous anesthesia with remimazolam

中文关键词: 外显记忆  内隐记忆  瑞马唑仑  全凭静脉麻醉  皮质醇

英文关键词: Explicit memory  Implicit memory  Remimazolam  Total intravenous anesthesia  Cortisol

中文摘要:

      
目的 评估瑞马唑仑全凭静脉麻醉（TIVA）下患者的外显记忆和内隐记忆，并观察皮质醇浓度。

方法 选择择期行全麻患者60例，男31例，女29例，年龄18～60岁，BMI 16 ～30 kg/m²，ASAⅠ—Ⅲ级。行BIS监测，维持BIS 40～60。根据听录音内容的不同，通过随机数字表法将患者分为三组：类别组（CT组）、单词组（WM组）和对照组（CG组），每组20例。CT组听五个中频动物词语，WM组听五个中频单词，CG组听大海声。术后1 h，在麻醉恢复室（PACU）对患者进行外显记忆和内隐记忆的评估。外显记忆评估，每组提问以下问题：（1）是否记得手术过程中的任何事情？（2）是否做梦？内隐记忆评估分组提问：（1）CT组行类别评估测试：请说出最先想到的5个动物名；（2）WM组行单词再认测试：请在10个中频词（其中5个在术中播放过）中选出近期听过的词。（3）CG组：提问前两组的所有问题，以获得基础值进行比较。于入室后、听录音20 min、术后1 h抽取静脉血，测定皮质醇。

结果 三组均报告不记得术中事件，CT组记得做梦2例，CG组记得做梦1例，三组差异无统计学意义。CT组和CG组类别评估测试差异无统计学意义。WM组和CG组单词再认测试差异无统计学意义。与入室后比较，听录音20 min CT组、WM组和CG组皮质醇明显降低（P<0.05），术后1 h CT组和WM组皮质醇明显升高（P<0.05）。与听录音20 min比较，术后1 h CT组、WM组和CG组皮质醇明显升高（P<0.05）。不同时点三组皮质醇差异无统计学意义。

结论 瑞马唑仑行全凭静脉麻醉时，BIS监测维持合适的麻醉深度下，未发现患者形成外显记忆或内隐记忆，术中皮质醇降低。

英文摘要:

      
Objective To assess explicit and implicit memory in patients who had surgery under total intravenous anesthesia (TIVA) with remimazolam and to observe cortisol levels.

Methods Sixty patients with TIVA, 31 males and 29 females, aged 18-60 years, BMI 16-30 kg/m², ASA physical status Ⅰ-Ⅲ, were selected. All patients were monitored by BIS and maintained at 40-60. According to the tapes they listened, patients were randomly allocated to three groups: the category group (group CT), the word recognition group (group WM), and the control group (group CG), 20 patients in each group. Patients in group CT listened to a tape containing five animal names. Patients in group WM listened to a tape containing five intermediate-frequency words. Patients in group CG listened to sea sounds. Tests were carried out to each patient in PACU to assess explicit and imlicit memory 1 hour after surgery. In order to evaluate explicit memory, the patients were asked the following two questions. 1. Did you remember anything between the beginning and the end of the surgery? 2. Did you have any dreams during the surgery? In order to evaluate implicit memory, the patients from group CT were asked to name the first five animals that came to mind. A list containing ten medium-frequency words (five of them had been played during the operation for the patients) were read to patients in group WM. They were then asked to pick the words they had heard before. Patients in group CG were asked the same questions as both groups CT and WM, by which basal values were acquired for comparison. The concentration of cortisol in venous blood was measured after room entry, 20 minutes after auditory recording, and 1 hour after surgery.

Results All the three groups reported no memory of intraoperative events. Two patients in group CT and one patient in group CG said they had dreamt. There was no significant difference in the three groups. There was no significant difference in category evaluation tests between groups CT and CG. There was no significant difference in word memory test between groups WM and CG. Compared with room entry point, cortisol decreased significantly in groups CT, WM, and CG 20 minutes after auditory recording point (P < 0.05), and cortisol was significantly higher in groups CT and WM 1 hour after surgery point (P < 0.05). Compared with 20 minutes after auditory recording point, cortisol was significantly higher in groups CT, WM, and CG at 1 hour after surgery point (P < 0.05). There was no significant difference in cortisol between the groups at each point.

Conclusion No evidence of explicit and implicit memory under adequate TIVA with remimazolam was found, and the intraoperative cortisol level has reduced.