不同镇静深度下瑞马唑仑对区域麻醉患者外显记忆和内隐记忆的影响

Effects of remimazolam at different depth of sedation on explicit and implicit memory in patients with regional anesthesia

目的观察瑞马唑仑在不同镇静深度下对区域麻醉手术患者外显记忆(EM)和内隐记忆(IM)的影响。方法选择区域麻醉下择期手术患者34例,男19例,女15例,年龄18~64岁,BMI 18~30 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组:浅镇静组(M组)和深镇静组(D组),每组17例。术中以0.1 mg·kg^(-1)·h^(-1)的起始剂量持续泵注瑞马唑仑1 mg/ml镇静,以0.1 mg·kg^(-1)·h^(-1)的梯度逐渐增加药量,M组维持BIS 60~80,D组维持BIS 40~60,术中在相应范围保持3 min以上,予以听词学习。停药后4~24 h记录简单问卷采访结果,包含测试和排除测试命中率、命中频率。使用加工分离程序(PDP)扩展测试模型评估EM和IM得分。记录镇静过程中托下颌面罩加压给氧,使用麻黄碱、阿托品等干预的不良事件发生情况。结果两组简单问卷采访结果无特殊,包含测试和排除测试命中率与命中频率差异无统计学意义。M组EM得分为0.041(-0.015~0.076),IM得分为0.198(0.043~0.353)。D组EM得分为0.080(0.004~0.151),IM得分为0.062(-0.003~0.114)。M组IM得分明显大于0(P<0.05)。两组镇静过程中未发生托下颌面罩加压给氧,使用麻黄碱、阿托品等干预的不良事件。结论瑞马唑仑在维持BIS 60~80的浅镇静状态下可以消除外显记忆,BIS 40~60的深镇静状态下可以同时消除外显记忆和内隐记忆。

Objective To assess the effects of different sedation depths of remimazolam on explicit memory(EM)and implicit memory(IM)in patients with regional anesthesia.Methods Thirty-four patients,19 males and 15 females,aged 18-64 years,BMI 18-30 kg/m^(2),ASA physical statusⅠorⅡ,underwent elective surgery under regional anaesthesia combined with remimazolam sedation,who were randomly divided into mild sedation group(group M)and deep sedation(group D),17 patients in each group.During the operation,the initial dose of 0.1 mg·kg^(-1)·h^(-1)was continuously injected with 1 mg/ml remimazolam for sedation,and the dosage was gradually increased at a gradient of 0.1 mg·kg^(-1)·h^(-1)to respectively controll BIS index at 60-80 in group M and 40-60 in group D for more than 3 minutes,and then auditory stimulation was given.Simple questionnaire interview results,including and excluding test hit rate and hit frequency were recorded after four to twenty-four hours of discontinuation.EM and IM scores were assessed by process dissociation procedure extended model.The occurrence of adverse events during sedation requiring mask pressurization and jaw-lift and intervention with ephedrine and atropine were recorded.Results There was no significant difference in hit rate and hit frequency between the two groups in the inclusion test and exclusion test,and the results of simple questionnaire interview in the two group were not special.EM and IM scores in group M were 0.041(-0.015 to 0.076)and 0.198(0.043 to 0.353),respectively.EM and IM scores in group D were 0.080(0.004 to 0.151)and 0.062(-0.003 to 0.114),respectively.The IM score was significantly greater than zero in the group M(P<0.05).There were no adverse events such as requiring mask pressurization and jaw-lift,using ephedrine and atropine during the sedation in the two groups.Conclusion Remimazolam can eliminate EM in the mild sedation of BIS 60-80,and EM and IM can be eliminated simultaneously in the deep sedation of BIS 40-60.