文章摘要
瑞马唑仑与丙泊酚全身麻醉下妇科手术患者外显记忆和内隐记忆的评估
Evaluation of explicit and implicit memory under gynecological general anesthesia with remazolam and propofol
  
DOI：10.12089/jca.2025.09.006
中文关键词: 瑞马唑仑  丙泊酚  外显记忆  内隐记忆  加工分离程序
英文关键词: Remimazolam  Propofol  Explicit memory  Implicit memory  Process dissociation procedure
基金项目:宁夏卫生健康科研项目（2025-NWQP-B012）；宁夏自然科学基金一般项目（2023AAC03474)
作者单位E-mail
马婷 750004,银川市,宁夏回族自治区人民医院,宁夏医科大学附属自治区人民医院麻醉科  
杨亚宁 750004,银川市,宁夏回族自治区人民医院,宁夏医科大学附属自治区人民医院麻醉科  
张文娟 750004,银川市,宁夏回族自治区人民医院,宁夏医科大学附属自治区人民医院麻醉科  
吴桠楠 750004,银川市,宁夏回族自治区人民医院,宁夏医科大学附属自治区人民医院麻醉科  
刘文勋 750004,银川市,宁夏回族自治区人民医院,宁夏医科大学附属自治区人民医院麻醉科 38361345@qq.com 
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中文摘要:
      
目的：探讨使用加工分离程序评估瑞马唑仑和丙泊酚全身麻醉下行妇科手术患者的外显记忆和内隐记忆。
方法：选择行全身麻醉下妇科手术的患者82例，随机将患者分为两组：瑞马唑仑组（R组，n=41）和丙泊酚组（P组，n=41），另随机选择内科住院女性患者40例作为对照组（C组，n=40），年龄18～60岁，BMI 18.5～30.0 kg/m2 ，ASA Ⅰ或Ⅱ级。 R组入手术室5 min听10个中频词语，麻醉诱导给予舒芬太尼0.25～0.5 μg/kg、瑞马唑仑0.2～0.3 mg/kg、顺式阿曲库铵0.15 mg/kg；P组入手术室5 min听10个中频词语，麻醉诱导给予舒芬太尼0.25～0.5 μg/kg、丙泊酚2～2.5 mg/kg、顺式阿曲库铵0.15 mg/kg；手术开始30 min两组再听10个中频词语。送入PACU 10 min时两组行改良Brice量表评估，待患者回到病房后6～24 h内行加工分离程序测试。C组听10个中频词语，6～24 h后行加工分离程序测试。记录麻醉维持瑞芬太尼用量、插管时间、意识恢复时间和拔管时间，入室时、诱导后5 min、手术开始后30 min、手术结束和出室时HR、SBP、DBP和BIS。
结果：R组和P组改良Brice量表评估结果差异无统计学意义。加工分离程序测试三组外显记忆得分差异无统计学意义。与P组比较，R组和C组内隐记忆得分明显降低（P＜0.05），R组意识恢复时间明显缩短，拔管时间明显延长（P＜0.05），R组诱导后5 min和手术开始后30 min HR明显增快（P＜0.05），诱导后5 min和手术结束时BIS明显升高（P＜0.05）。
结论：维持BIS 40～60的麻醉深度下，妇科全麻手术使用瑞马唑仑和丙泊酚时，两者均未发现明显的外显记忆，但使用丙泊酚在术后6～24 h内形成内隐记忆的风险比瑞马唑仑更高。
英文摘要:
      
Objective: To assess explicit and implicit memory in patients who had gynaecological surgery under general anaesthesia with remimazolam and propofol using a processing dissociation procedure.
Methods: Eighty-two patients undergoing gynecological surgery under general anaesthesia were selected and randomly divided into two groups: the remimazolam group (group R, n = 41) and the propofol group (group P, n = 41). Additionally, 40 female inpatients from the departments of gastroenterology, respiratory medicine, and rheumatology were randomly selected as the control group (group C, n = 40). Inclusion criteria were: aged 18-60 years, BMI 18-30 kg/m2, ASA physical status Ⅰ or Ⅱ. Patients in group R listened to ten medium-frequency words 5 minutes after entering the operating room. Anesthetic induction consisted of sufentanil 0.25-0.5 μg/kg, remimazolam 0.2-0.3 mg/kg, and cisatracurium 0.15 mg/kg. Patients in group P listened to ten medium-frequency words 5 minutes after entering the operating room. Anesthetic induction consisted of sufentanil 0.25-0.5 μg/kg, propofol 2.0-2.5 mg/kg, and cisatracurium 0.15 mg/kg. Both groups listened to ten medium-frequency words again 30 minutes after surgical incision. The modified Brice questionnaire was administered to both groups 10 minutes after admission to the PACU. Process dissociation procedure testing was performed 6-24 hours after patients returned to the ward. Patients in group C listened to ten medium-frequency words, followed by process dissociation procedure testing 6-24 hours later. The amount of remifentanil used for anesthesia maintenance, intubation time, consciousness recovery time, and extubation time were recorded, as well as HR, SBP, DBP, and BIS at the time of entry, 5 minutes after induction, 30 minutes after surgical incision, end of surgery, and exit from the operating room.
Results: There was no significant difference in the modified Brice scale between groups R and P. Process dissociation procedure testing revealed no statistically significant differences in explicit memory scores among the three groups. Compared with group P, the implicit memory scores in groups R and C were significantly decreased (P < 0.05), the consciousness recovery time in group R was significantly shortened, and the extubation time was significantly prolonged (P < 0.05), HR in group R increased significantly 5 minutes after induction and 30 minutes after surgical incision (P < 0.05), and the BIS increased significantly 5 minutes after induction and at the end of surgery (P < 0.05).
Conclusion: Maintaining a depth of anaesthesia of BIS 40-60, no significant episodic memory was found for either remimazolam or propofol when used for gynaecological general anaesthesia procedures, but propofol had a higher risk of forming implicit memory than remimazolam.
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