静吸复合麻醉与静脉麻醉对妇科肿瘤手术患者内隐记忆、外显记忆及应激反应的影响

Effects of intravenous-inhalational anesthesia and intravenous anesthesia on implicit, explicit memory and stress response in patients undergoing gynecological tumor surgery

目的探讨丙泊酚复合七氟烷静吸麻醉与丙泊酚静脉麻醉对妇科肿瘤手术患者内隐记忆、外显记忆以及应激反应的影响。方法选择2018年8月至2019年5月山西医科大学第二医院妇科肿瘤手术患者48例,应用随机数字表法将患者分为丙泊酚静脉麻醉组(A组)和丙泊酚复合七氟烷静吸麻醉组(B组),每组24例。A组术中丙泊酚持续静脉泵注,B组术中丙泊酚持续静脉泵注复合七氟烷吸入,七氟烷最低肺泡有效浓度(MAC)维持在0.5,两组麻醉过程中均不使用咪达唑仑。术中两组脑电双频指数(BIS)值均维持在45~55,并在麻醉诱导前(T1)和术中听录音后10 min(T2)抽取肘静脉血测量皮质醇、促肾上腺激素释放激素(ACTH)及催乳素(PRL)浓度,在术后12~24 h进行记忆测试并计算内隐记忆及外显记忆成绩。结果A组外显记忆成绩为0.012±0.007,B组为0.016±0.002,两组均未产生外显记忆[与0(常数)比较,A组:t=1.554,P>0.05;B组:t=1.942,P>0.05],两组间的外显记忆成绩差异无统计学意义(t=-0.417,P>0.05)。A组内隐记忆成绩为0.089±0.050,B组为0.189±0.060,两组均产生内隐记忆[与0(常数)比较,A组:t=8.726,P<0.05;B组:t=15.415,P<0.05],B组内隐记忆成绩更高(t=-6.215,P<0.05)。两组间T1时刻皮质醇、ACTH及PRL水平差异均无统计学意义(均P>0.05),T2时刻B组皮质醇、ACTH及PRL水平均高于A组[(276±35)μg/L比(96±33)μg/L;(228±42.3)pg/ml比(14.1±1.7)pg/ml;(4208±213)mU/ml比(3805±196)mU/ml],差异均有统计学意义(t值分别为18.634、34.879、12.605,均P<0.05)。结论丙泊酚静脉麻醉较丙泊酚复合七氟烷静吸麻醉能更好地抑制内隐记忆的产生以及术中应激反应。

Objective To investigate the effects of propofol combined with sevoflurane intravenous-inhalational anesthesia and propofol intravenous anesthesia on implicit memory,explicit memory and stress response in patients undergoing gynecological cancer surgery.Methods A total of 48 patients undergoing gynecologic cancer surgery in the Second Hospital of Shanxi Medical University from August 2018 to May 2019 were selected.Random number table was used to divide patients into propofol intravenous anesthesia group(group A)and propofol combined with sevoflurane intravenous-inhalational anesthesia group(group B),24 cases in each group.During the operation,the patients in group A were given continuous intravenous anesthesia with propofol and the patients in group B were given continuous intravenous anesthesia with propofol combined with sevoflurane.Minimal alveolar concentration(MAC)of sevoflurane was 0.5,and midazolam was not utilized throughout the whole anesthesia for both groups.The bispectral index(BIS)value of the two groups ranged from 45 to 55 during the operation.The concentration of cortisol,adrenocorticotropic hormone(ACTH)and prolactin(PRL)in elbow venous blood was measured before anesthesia induction(T1)and 10 minutes after intraoperative auditory recording(T2).Implicit and explicit memory scores were measured 12-24 h after operation.Results Neither group produced explicit memory compared with 0(group A:0.012±0.007,t=1.554,P>0.05;group B:0.016±0.002,t=1.942,P>0.05),and there was no significant difference in explicit memory score between the two groups(t=-0.417,P>0.05).Both groups produced implicit memory(group A:0.089±0.050,t=8.726,P<0.05;group B:0.189±0.060,t=15.415,P<0.05),and implicit memory score was higher in group B(t=-6.215,P<0.05).The level of cortisol,ACTH and PRL at time T1 was not significantly different between the two groups(all P>0.05),and the level of cortisol,ACTH and PRL in group B was higher than that in group A at time T2[(276±35)μg/L vs.(96±33)μg/L;(228±42.3)pg/ml vs.(14.1±1.7)pg/ml;(4208±213)mU/ml vs.(3805±196)mU/ml;t value was 18.634,34.879,12.605,all P<0.05].Conclusion Propofol intravenous anesthesia can better inhibit the production of implicit memory and intraoperative stress response compared with propofol combined with sevoflurane intravenous-inhalational anesthesia.