目的：探讨血浆Orexin A水平与全身麻醉术中知晓发生的相关性。方法采用前瞻性配对病例对照研究，共收集术中知晓病例33例，对照病例33例，分别测定两组患者手术当天清晨7：00（术前）、麻醉开始后30 min（全麻后）2个时点的血浆Orexin A水平。比较血浆Orexin A水平的组间差异，分析病例组中术前血浆Orexin A水平与术中知晓病情分级的相关性。结果与术前血浆Orexin A水平比较，病例组及对照组全麻后的血浆Orexin A水平均有明显下降，差异有统计学意义，病例组 Orexin A水平麻醉后的下降程度较对照组小，差异有统计学意义。术前、全麻后病例组与对照组的血浆Orexin A水平差异均有统计学意义。Spearman等级相关分析表明,病例组术前血浆Orexin A水平与术中知晓的病情分度成正相关（r=0.695，P=0.031）。结论血浆Orexin A水平升高与术中知晓的发生以及术中知晓的病情分级有关，Orexin系统可能在术中知晓发生的病理生理中起着重要作用，检测血浆Orexin A水平可对预防术中知晓及其相关创伤性应激后障碍提供积极的指导意义。%Objective To explore the relationship between plasma Orexin-A level and intraoperative awareness. Methods A prospective match case-control study was conducted. Experiment group included thirty-three cases with intraoperative awareness and control group another thirty-three cases without. Plasma Orexin-A level before operation and after general anesthesia were determined. Intergroup plasma Orexin-A level difference and relationship between plasma Orexin-A level and intraoperative awareness grade were compared and analyzed. Results Plasma Orexin-A level reduced significantly after general anesthesia in both groups, but with a smaller degree in observation group, which showed statistical significance. Intergroup comparison of plasma Orexin-A level before the operation and after general anesthesia indicated statistical significance. Spearman correlation analysis revealed there was positive relationship between preoperative plasma Orexin-A level and intraoperative awareness grade ( r=0.695, P=0.031). Conclusion The increase of plasma Orexin-A level is related to intraoperative awareness grade and Orexin system seems to play a significant role in preventing intraoperative awareness and related posttraumatic stress disorder.
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