丙泊酚复合瑞芬太尼对内隐记忆和外显记忆的影响

Effect of propofol combined with remifentanil on implicit and explicit memory

目的探讨丙泊酚复合瑞芬太尼静脉麻醉对内隐记忆和外显记忆的影响。方法选择90例男性健康志愿者,随机双盲分为3组:A组靶控输注丙泊酚1.5μg/ml复合持续泵注瑞芬太尼0.05μg/(kg·min),B组靶控输注丙泊酚2.0μg/ml复合持续泵注瑞芬太尼0.05μg/(kg·min),C组靶控输注丙泊酚1.5μg/ml复合持续泵注瑞芬太尼0.1μg/(kg·min)。每位志愿者分别在给药前和给药20 min后给予听词刺激。试验完毕后2 h采用加工分离程序对志愿者进行包含和排除测验,并推算内隐记忆和外显记忆成绩。记录2次听词刺激时点的血压、心率、氧饱和度和脑电双频谱指数。结果A组外显记忆成绩与0相比差异无统计学意义(P>0.05),内隐记忆成绩显著大于0(P<0.05)。B组和C组的外显记忆显记忆和内隐记忆成绩与0相比差异均无统计学意义(P>0.05)。结论靶控输注丙泊酚1.5μg/ml复合持续泵注瑞芬太尼0.05μg/(kg·min)可消除外显记忆,但内隐记忆仍保留。增加丙泊酚或瑞芬太尼的输注剂量均可加强全静脉麻醉的遗忘作用,致使外显记忆和内隐记忆均消失。

Objective To quantitatively investigate the effect of propofol combined with remifentanil on explicit and implicit memory through process dissociation procedure. Methods Ninety male volunteers were randomly double-blindedly allocated to 3 groups： group A received propofol 1.5 μg/ml via target controlled infusion combined with remifentanil 0.05 μg/（kg .min）; group B received propofol 2.0 Ixg/ml via target controlled infusion combined with remifentanil 0.05 μg/（kg .min）; group C received propofol 1.5 μg/ml via target controlled infusion combined with remifentanil 0.1 μg/（kg .min）. Each volunteer was given auditory stimulus before and 20 minutes after infusion. Two hours later, the inclusion test and exclusion test were performed. The process dissociation procedure combined with word stem completion was used to estimate the scores of explicit and implicit memory. BP, HR, SpO2 and bispectral index during auditory stimulus were recorded. Results There was no significant difference between explicit memory scores and zero in group A （P 〉 0.05）, but the implicit memory scores were statistically greater than zero in group A （P 〈 0.05）. There was no significant difference between explicit memory scores and zero or between implicit memory and zero in group B and C （P 〉 0.05）. Conclusion Propofol 1.5 μg/ml via target controlled infusion Combined with remifentanil 0.05 μg/（kg .min） only abolish explicit memory. Increasing propofol or remifentanil both enhance the amnesia effect and resuh in loss of explicit and implicit memory.