术中唤醒试验对舒芬太尼镇痛下脊柱侧弯矫形术患者术后谵妄的影响

Effect of intraoperative wake-up test on postoperative delirium in patients undergoing scoliosis surgery under analgesia with sufentanil

目的 评价术中唤醒试验对舒芬太尼镇痛下脊柱侧弯矫形术患者术后谵妄的影响。方法拟行脊柱侧弯矫形术患者60例，年龄12～60岁，ASA分级Ⅰ或Ⅱ级。采用分层随机法，将患者随机分为2组（n=30）：术中不行唤醒试验组（C组）和术中唤醒试验组（w组）。麻醉诱导：靶控输注舒芬太尼，Ce0．5ng／ml，静脉注射异丙酚1～2mg／kg、顺苯磺阿曲库铵0．15mg／kg，气管插管后行机械通气。麻醉维持：靶控吸入七氟醚，呼气末靶浓度0．8％～1．5％，靶控输注舒芬太尼，Ce0．2～0．3ng／ml，静脉输注顺苯磺阿曲库铵0．1mg·kg^-1·h^-1。术中两侧内固定棒安装后，W组行唤醒试验。术后采用舒芬太尼镇痛。术后3d内维持患者夜间睡眠8h以上。记录术中知晓和术后谵妄发生情况。结果两组术中知晓和术后谵妄发生率比较差异无统计学意义（P〉0．05）。结论对舒芬太尼镇痛下脊柱侧弯矫形术患者，术中唤醒试验并非术后谵妄发生的危险因素，可能与舒芬太尼镇痛有效地抑制围术期疼痛及术中知晓有关。

Objective To investigate the effect of the intraoperative wake-up test on the postoperative delirium in patients undergoing scoliosis operation under analgesia with sufentanil. Methods Sixty ASA Ⅰ or Ⅱ patients, aged 12-60 yr, scheduled for scoliosis surgery, were randomly divided into 2 groups （ n = 30 each） ： control group （group C） and intraoperative wake-up test group （group W）. The intraoperative wake-up test was not performed during operation in group C. Anesthesia was induced with target-controlled infusion of sufentanil with the target effect-site concentration set at 0.5 ng/ml and iv injection of propofol 1-2 mg/kg. As soon as the patients lost , tracheal intubation was facilitated with 0.15 mg/kg cisatracurium besylate. The patients were mechanically ventilated. Anesthesia was maintained with target-controlled inhalation of sevoflurane （target end-tidal concentration 0.8%-1.5% ）, target-controlled infusion of sufentanil （ target effect-site concentration 0.2-0.3 ng/ml） and iv infusion of cisatracurium besylate 0.1 mg· kg·h^-1 . In group W, the patients underwent the intraoperative wake-up test. Postoperative analgesia was provided with sufentanil. The occurrence of intraoperative awareness and postoperative delirium was recorded. Results No significant difference was found in the incidences of intraoperative awareness and postoperative delirium between the two groups. Conclusion The intraoperative wake-up test is not the risk factor for postoperative delirium in patients undergoing scoliosis surgery under analgesia with sufentanil, and inhibition of perioperative pain and intraoperative awareness by analgesia with sufentanil may be involved in the mechanism.