三种全凭静脉麻醉患者术中知晓的对比研究

Comparative study of three methods in total intravenous anesthesia of awareness during the surgery

目的 对比三种全凭静脉麻醉方法中全身麻醉患者术中知晓的发生情况,探讨术中知晓的影响因素及预防策略,减少术中知晓的发生.方法 选择择期手术的全身麻醉患者632例,随机分为三组,A组214例,以咪达唑仑0.05 mg/kg、顺苯磺酸阿曲库铵0.2mg/kg、舒芬太尼2μg/kg、丙泊酚2.0 mg/kg行麻醉诱导,麻醉维持TCI丙泊酚血浆靶浓度2.5 ～3.0 μg/ml,顺苯磺酸阿曲库铵2μg/（kg＆#183;min）,TCI瑞芬太尼血浆靶浓度4.5～5.5 ng/ml;B组207例,除麻醉诱导无咪达唑仑外,其余同A组;C组211例,麻醉维持TCI丙泊酚血浆靶浓度增加到3.8～4.8 μg/ml,顺苯磺酸阿曲库铵减至0.5 ～1.0μg/（kg＆#183;min）,其余同B组.分别于术后第1天和第5天进行术后随访,记录术中知晓的发生情况.结果 B组术中知晓的发生率与C组比较差异未见统计学意义（P＞0.05）,但明显低于A组（P＜0.05）.结论 应用小剂量咪达唑仑或丙泊酚维持在一定血浆浓度可以减少和预防全凭静脉麻醉术中知晓.

Objective To compare the three methods in total intravenous anesthesia of awareness during the surgery occurs in patients,and investigate the influence of intraoperative awareness factors and prevention strategies,in order to reduce the incidence of intraoperative awareness.Methods Six hundred and thirty-two cases underwent elective surgery with general anesthesia were selected,the patients were randomly divided into three groups,214 cases in group A,with 0.05 mg/kg of midazolam,0.2 mg/kg of cisatracurium besylate,2 μg/kg of sufentanil,2.0 mg/kg of propofol for induction of anesthesia,to maintain the target plasma concentration of TCI propofol with 2.5-3.0 μg/ml,cisatracurium besylate 2 μg/（kg ＆#183; min）,with target plasma concentration of TCI remifentanil 4.5-5.5 ng/ml;207 cases in group B,in addition to induction of anesthesia without midazolam,the rest were the same as the group A;211 cases in group C,the maintained target plasma concentration of TCI propofol of anesthesia increased to 3.8-4.8 μg/ml,cisatracurium besilate reduced to 0.5-1.0 pg/（kg ＆#183; min）,the rest were the same as the group B.The patients were followed-up on the first and fifth day after surgery respectively,and the awareness during the surgery was recorded.Results There were no significant difference between group B and group C in awareness during the surgery （P 〉 0.05）,but that was significantly lower than that of group A （P 〈 0.05）.Conclusions The application of small dose of midazolam or propofol maintaining certain plasma concentration,can reduce and prevent awareness during the surgery in total intravenous anesthesia.