异丙酚复合右美托咪定麻醉对术中知晓和术后记忆的影响
Influence of propofol combined with dexmedetomidine on intraoperative awareness and postoperative memory

目的:探讨异丙酚复合右美托咪定对术中知晓和术后记忆的影响。方法:180例行择期手术的全麻患者分为观察组(A组、B组、C组)和对照组(A0组、B0组、C0组)共6组,先行靶控输注异丙酚,再分别输注右美托咪定(观察组)或生理盐水(对照组)。观察记录手术过程中各组患者血流动力学指标以及脑电双频谱指数(BIS)和麻醉深度指数(CSI)的变化,并随访和记录术中知晓和术后记忆的情况。结果:麻醉诱导后和气管插管后各时间点观察组fH和pMA低于对照组(P<0.05)。对照组CI明显下降,观察组均无明显变化。插管后观察组pCV明显高于对照组(P<0.05)。所有患者在T2时点BIS和CSI值的差异有统计学意义(P<0.05)。在给予右美托咪定后A、B组患者从T3后BIS和CSI与其对照组比较下降(P<0.05)。C组患者各时点BIS值与C0组比较无明显改变,但CSI值仍然下降(P<0.05)。除A、A0组外所有患者均未回忆出术中事件及相关的梦。结论:异丙酚复合右美托咪定较单独靶控输注异丙酚全身麻醉具有更好的增强效果,减少术中知晓和术后记忆,避免了患者的术后焦虑等心理上并发症的发生。
Aim: To investigate the influence of propofol combined with dexmedetomidine on intraoperative awareness and postoperative memory.Methods: A total of 120 patients waiting for general anesthesia before surgery were allocated into observation groups(A, B, C)and control groups(A0, B0, C0). Target controlled infusion(TCI)of propofol was performed in advance, then dexmedetomidine infusion for the observation group and normal saline infusion for the control group were carried out, respectively. Bispectral index(BIS)and cerebral state index(CSI)values during the study were observed and recorded, as well as changes in hemodynamic indexes, and the intraoperative awareness and postoperative memory were recorded.Results: After induction of anesthesia and intubation, the fH and pMA of the observation group at different time points were lower than that of the control group(P<0.05). CI in the control group decreased significantly, while that in the observation group had no significant changes. After intubation, the pCV of the observation group was significantly higher than that of the control group(P<0.05).The values of BIS and CSI for all patients at T2 had statistical differences(P<0.05).After being given dexmedetomidine, BIS and CSI of the patients in group A and B at T3 decreased compared with those in the control group(P<0.05).BIS values for patients in group C at each time point did not change significantly compared with that in control group, while the CSI values were still declining(P<0.05). Except for the patients in group A and A0, all the other patients did not had memories of intraoperative events and related dreams.Conclusion: Propofol combined with dexmedetomidine has better enhancement effect compared with propofol TCI alone in general anesthesia,and the intraoperative awareness and postoperative memory reduced,which could avoid the occurrence of postoperative anxiety and other psychological complications