摘要
目的 :探讨硬膜外麻醉时术中异丙酚联合咪达唑仑镇静对内隐记忆的影响 ,分析内隐记忆消失的中潜伏期听觉诱发电位 (MLAEP)参数界值 ,为临床镇静深度监测提供一项新的客观指标。方法 :硬膜外麻醉下择期手术病人 4 5例 (ASAⅠ～Ⅱ级 ) ,随机分为P、PM1 、PM2 3组 ,每组 1 5例。镇静 1 5min后 ,给予内隐记忆听刺激。记录入室时、行硬膜外麻醉后、静脉给药后 1 5min、切皮后 2min、内隐记忆刺激完成即刻等时点的HR、MAP、MLAEP。术后 6h进行记忆调查。结果 :异丙酚镇静Pa、Nb 波潜伏期延长、波幅降低 (P <0 .0 5 ) ,但联合用药组潜伏期延长更明显、波幅降得更低 (P <0 .0 5 )。所有患者外显记忆均消失 ;P组病人均存在内隐记忆 ,两联合用药组病人内隐记忆均消失。结论 :小剂量异丙酚和咪达唑仑联合镇静可以消除外显记忆和内隐记忆。MLAEP参数Pa、Nb 波潜伏期。
Objective: To search the objective indicator for monitoring the depth of sedation,by analyzing the effects of propofol midazolam on implicit memory and the changes of parameters of MLAEP. Methods: Forty five patients (ASA Ⅰ～Ⅱ) undergoing elective surgery under epidural anesthesia were enrolled in this study. The patients were randomly divided into three groups: Group P( n =15),Group PM 1( n =15) and Group PM 2( n =15). After 15 min after sedation,all patients were given an audiotape. The changes of HR,MAP,MLAEP were recorded preanesthesia,postanesthesia,15 min after sedation,2 min after skin incision and after audiotape presentation. Six hours after operation,the patients memory was tested directly and indirectly. Results: P a/N b latencies were increased and P a/N b amplitudes were suppressed after propofol sedation( P <0.05). The changing trends of MLAEP with propofol midazolam sedation was in accordance with propofol sedation,but P a/N b latencies were longer and P a/N b amplitudes were lower after propofol midazolam sedation( P <0.05). We did not find any evidence of intraoperative explicit memory among all patients. Implicit memory was spared in Group P. However,it was eliminated in Group PM 1 and Group PM 2 . Conclusions: Explicit memory and implicit memory can be eliminated by the small dose of propofol in combination with midazolam. P a/N b latencies and amplitudes can be used as an effective indicator to evaluate the depth of anesthesia or sedation during surgery.
出处
《广州医学院学报》
2003年第3期14-17,共4页
Academic Journal of Guangzhou Medical College
