摘要
目的 研究异丙酚靶控输注(TCI)不同镇静深度对记忆的影响,探讨内隐记忆与脑电双频指数(BIS)、听觉诱发电位指数(AEPI)和异丙酚效应室药物浓度之间的关系。方法36例行择期下肢手术的患者,在硬膜外麻醉后TCI异丙酚镇静,根据镇静水平的不同随机分为3组,A组OAA/S评分3分,B组OAA/S评分2分,C组OAA/S评分1分。各组在镇静前呈现一次听刺激,达目标镇静深度后呈现第二次听刺激。监测第二次听刺激呈现前后的BIS和AEPI值。试验完毕后4 h采用加工分离程序对患者进行包含和排除测验,并推算内隐记忆和外显记忆成绩。结果 A组外显记忆和内隐记忆成绩与0相比差异有显著性(P<0.05);B组镇静期外显记忆成绩与0相比差异无显著性(P>0.05),内隐记忆成绩与0相比差异有显著性(P<0.05);C组外显记忆和内隐记忆成绩与0相比差异均无显著性(P>0.05)。A、B两组镇静期内隐记忆成绩差异无显著性(P>0.05)。内隐记忆成绩与BIS和AEPI有明显的相关性(P<0.01)。BIS、AEPI和效应室药物浓度均可很好地预测内隐记忆消失与否(P<0.01)。ROC曲线下面积:BIS>AEPI>效应室药物浓度。应用BIS、AEPI和效应室药物浓度诊断内隐记忆消失与否的截断点分别是:47、28、2.3 μg/ml。结论 在无伤害性刺激传入、无意识的情况下仍存在内隐记忆。
Objective To investigate the effect of different levels of sedation with propofol given by TCI on learning and memory and the relationship between memory and bispectral index (BIS), auditory evoked potential index (AEPI), effect-site concentration. Methods Thirty- six ASA Ⅰ - Ⅱ patients of either sex, aged 18-48 yr, undergoing operation on lower extremities were randomly assigned to one of three groups of 12 patients : group A = OOA / S score 3 ( only respond to loud or repeated request for eye-opening); group B = 00A / S score 2 ( only respond to light patting ) and group C = OOA / S score 1 ( only respond to squeezing the deltoid muscle ). The patients were subjected to the first auditory stimulus before sedation. The second stimulus was given when the target level of sedation was reached. BIS and AEP were monitored before and after the second auditory stimulation. Four hours after the experiment, the inclusion and exclusion test were performed on the surgical ward using process dissociation procedure and the explicit and implicit memory scores were determined. Results In group A, explicit and implicit memory scores were statistically greater than zero during sedation ( P < 0.05) . In group B only the implicit memory scores exceeded zero ( P < 0.05); whereas the explicit memory scores did not ( P > 0.05) . In group C both the explicit and implicit memory scores did not exceed zero ( P > 0.05). There was no significant difference in the implicit memory scores between group A and B during sedation. Implicit memory scores correlated well with BIS index and AEPI (P < 0.01). The BIS index, AEPI and effect-site concentration could predict the implicit memory (P<0.01). The area under ROC curve : BIS index > AEPI > effect-site concentration. The cutoff points of BIS index, AEPI and effect-site concentration for implicit memory were 47, 28 and 2.3 μg · ml-1 respectively.Conclusion Implicit memory exists in unconscious patients when there is no noxious stimulation. Implicit memory disappears at level 1 of OAA / S score. Implicit memory score correlates well with BIS index, AEPI. The BIS index, AEPI and effect-site concentration are good predictors of implicit memory during target-controlled infusion of propofol.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2004年第2期105-108,共4页
Chinese Journal of Anesthesiology
