目的：分析环泊酚复合瑞芬太尼全麻在 ROSA 机器人辅助脑深部电刺激术（DBS）中的作用。方法：选 取 2021 年 6 月—2023 年 6 月在南京脑科医院实施 ROSA 机器人辅助脑深部电刺激术的 100 例患者作为研究对象， 根据患者术中麻醉方式的不同，将其分为对照组（n=50）和观察组（n=50），其中对照组行利多卡因和罗哌卡因局 部麻醉，观察组行环泊酚复合瑞芬太尼全麻。比较两组患者手术相关指标、丘脑底核（STN）频率、镇静效果、血 清相关指标、应激反应等。结果：观察组手术时间、拔管时间短于对照组，术中出血量、颅内积气体积低于对照组， 且观察组 STN 频率高于对照组，记录长度短于对照组（P<0.05）。术毕时，观察组镇静评分为高于对照组，差异具 有统计学意义（P<0.05）。与术前相比，两组患者应激反应均有所波动，观察组应激反应波动幅度较对照组更小， 观察组血清指标优于对照组，麻醉恢复期不良反应发生率低于对照组（P<0.05）。结论：对于实施 ROSA 机器人辅 助 DBS 的患者，在术中采用环泊酚复合瑞芬太尼全麻，能获得较好的麻醉效果，且能够缩短手术时间、减少围术期 患者应激反应的波动水平，有效抑制患者血清 S-100β、NSE 水平，有助于保护脑组织。

Objective: To analyze the effect of general anesthesia with propofol and remifentanil in ROSA robot-assisted deep brain stimulation (DBS). Methods: A total of 100 patients who underwent ROSA robot-assisted DBS in Nanjing Brain Hospital from June 2021 to August 2023 were enrolled. According to the different anesthesia methods used during the surgery, the enrolled patients were divided into the control group (n=50) and the observation group (n=50). The control group received local anesthesia with lidocaine and ropivacaine, and the observation group received general anesthesia with propofol and remifentanil. Surgical indicators, subthalamic nucleus (STN) frequency, sedative effect, serum related indicators, stress response of patients were compared between two groups. Results: The observation group had shorter operative and extubation time compared to the control group, with lower intraoperative bleeding and intracranial gas volume. The observation group had higher STN frequency and shorter recording length than the control group (P<0.05). At the end of the surgery, the sedation scores of patients in the observation group was higher than those in the control group, with a significant difference (P<0.05). Both groups of patients showed fluctuations in stress response. The fluctuation amplitude of stress response in the observation group was smaller than that in the control group. The serum indicators in the observation group were better than those in the control group, and the incidence rate of adverse reactions in the observation group during anesthesia recovery were lower than those in the control group (P<0.05). Conclusion: For patients undergoing ROSA robot-assisted DBS, general anesthesia of propofol combined with remifentanil can achieve good anesthesia effects, shorten operative time, lower the fluctuation level of perioperative stress response, and effectively inhibit serum S-100 β and NSE levels, which has a protective effect on brain tissue.

收稿日期：2024-04-08  录用日期：2024-05-22 

Received Date: 2024-04-08  Accepted Date: 2024-05-22 

基金项目：江苏省重点研发计划（BE2022049，BE2022049-1） 

Foundation Item: Key R&D Plan of Jiangsu Province (BE2022049, BE2022049-1) 

通讯作者：徐娇，Email：XJxujiaodeng@163.com 

Corresponding Author: XU Jiao, Email: XJxujiaodeng@163.com 

引用格式：蒋慧慧，徐娇，陆军，等 . ROSA 机器人辅助脑深部电刺激术中麻醉优化的探讨 [J]. 机器人外科学杂志（中英文）， 2024，5（5）：853-858. 

Citation: JIANG H H, XU J, LU J, et al. Exploration of anesthesia optimization during ROSA robot-assisted deep brain stimulation [J]. Chinese Journal of Robotic Surgery, 2024, 5(5): 853-858.

[1] LIU C Y, YUAN M, HE S B. Patients with Parkinson’s disease demonstrate deficits in visual-spatial memory in the Chinese Visual Retention Test[J]. Brain and Behavior, 2023, 14(1): e3345-e3345. 

[2] Meligy F Y, Elgamal D A, Abd Allah E S H, et al. Retraction Note: testing alternatives: the use of adipose-derived mesenchymal stem cells to slow neurodegeneration in a rat model of Parkinson’s disease[J].Molecular Biology Reports, 2023, 51(1): 34-34. 

[3] 马清清 , 苏雪 , 袁田 , 等 . 外周炎症和中枢炎症在帕金森病发病 机制中的作用 [J]. 中国临床神经科学 , 2023, 31(6): 709-714, 720. 

[4] 徐明 , 陶英群 , 金海 , 等 . 丙泊酚瑞芬太尼全麻对机器人辅助丘 脑底核脑深部电刺激术的影响 [J]. 中国微侵袭神经外科杂志 , 2021, 26(4): 163-166. 

[5] 杜危 , 何婧 , 崔壮 , 等 . 帕金森病患者脑深部电刺激术后总输出 电能变化及相关因素分析 [J]. 临床神经病学杂志 , 2023, 36(3): 185-191. 

[6] 李锦汶 , 吴姗姗 , 王宁 , 等 . 右美托咪定复合瑞芬太尼全身麻 醉对帕金森综合征患者脑深部电刺激术中靶点定位及血清 S-100β、NSE 的影响 [J]. 临床误诊误治 , 2023, 36(2): 143-148. 

[7] 中国医师协会神经内科医师分会中华医学会神经病学分会帕金森 病及运动障碍学组 . 中国帕金森病重复经颅磁刺激治疗指南 [J]. 中国神经精神疾病杂志 , 2021, 47(10): 577-585. 

[8] 苗婷 , 张晓花 , 湛守青 . Ramsay 镇静评分法在主动脉夹层病人 孙氏手术后监护中的应用效果 [J]. 中西医结合心脑血管病杂志 , 2023, 21(17): 3238-3242. 

[9] Smeets S, Boogers A, van Bogaert T, et al. Deep brain stimulation with short versus conventional pulse width in Parkinson’s disease and essential tremor: a systematic review and meta-analysis[J]. Brain Stimulation, 2023, 17(1): 71-82. 

[10] Vijiaratnam N, Simuni T, Bandmann O, et al. Progress towards therapies for disease modification in Parkinson’s disease[J]. Lancet Neurol, 2021, 20(7): 559-572. 

[11] Borsche M, Pereira S L, Klein C, et al. Mitochondria and Parkinson’s disease: clinical, molecular, a nd translational aspects[J]. J Parkinsons Dis, 2021, 11(1): 45-60. 

[12] MENG W Y, ZHANG C, WU C Z, et al. Research progress on transcranial electrical stimulation for deep brain stimulation[J]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi, 2023, 40(5): 1005-1011. 

[13] Louviot S, Tyvaert L, Maillard L G, et al. Transcranial Electrical Stimulation generates electric fields in deep human brain structures[J]. Brain Stimul, 2022, 15(1): 1-12. 

[14] 王珏 , 邱娴 , 高颖等 . 帕金森病患者双侧丘脑底核脑深部电刺 激术后 2 年非运动症状的研究 [J]. 立体定向和功能性神经外科 杂志 , 2023, 36(04): 193-199. 

[15] 韩俊萍 , 沈珠 , 罗兴献 , 等 . 环泊酚与丙泊酚用于无痛胃肠镜疗 效与安全性的 Meta 分析 [J]. 中南药学 , 2023, 21(09): 2495-2500. 

[16] 郭顺 , 曾晓琴 , 李波 , 等 . 环泊酚与丙泊酚用于腹腔镜胆囊切 除术全麻诱导与维持的比较 [J]. 临床麻醉学杂志 , 2023, 39(06): 601-604. 

[17] Mostofi A, Morgante F, Edwards M J, et al. Pain in Parkinson’s disease and the role of the subthalamic nucleus[J]. Brain, 2021, 144(5): 1342-1350. 

[18] Emmi A, Campagnolo M, Stocco E, et al. Neurotransmitter and receptor systems in the subthalamic nucleus[J]. Brain Struct Funct, 2023, 228(7): 1595-1617. 

[19] 刘佳明 , 张兰 , 张青霞 , 等 .1 例体外膜肺氧合重症患者的抗感 染治疗及血药浓度异常值的分析与药学监护 [J]. 中国药物应用 与监测 , 2021, 18(4): 232-234, 238. 

[20] 曹立娟 , 郑慧 , 谢永鹏 , 等 . 预氧合联合窒息氧合对危重症患者 气管插管影响的网状 Meta 分析 [J]. 中华危重病急救医学 , 2019, 31(10): 1236-1241. 

[21] Kishore J, Shaikh F, Zubairi A M, et al. Evaluation of serum neuron specific enolase levels among patients with primary and secondary burning mouth syndrome[J]. Cephalalgia, 2022, 42(2): 119-127. 

[22] Gönen M, Özdoğan S, Balgetir F, et al. S100B and neuron-specific enolase levels in episodic and chronic migraine[J]. Acta Neurol Scand, 2021, 143(3): 298-302. 

[23] Hanin A, Demeret S, Denis J A, et al. Serum neuron-specific enolase: a new tool for seizure risk monitoring after status epilepticus[J]. Eur J Neurol, 2022, 29(3): 883-889. 

[24] 李先超 , 杨云朝 , 喻希 , 等 . 环泊酚对小鼠心肌缺血再灌注损伤 的保护作用及其机制研究 [J]. 中国心血管病研究 , 2023, 21(10): 956-960. 

[25] 尚平平 , 刘晓宁 , 范军朝 , 等 . 环泊酚通过 Wnt/β-catenin 信 号通路对帕金森病大鼠的神经保护作用 [J]. 现代药物与临床 , 2022, 37(3): 453-457. 

[26] 王悠笛 , 陈亮 , 孙盈盈 , 等 . 环泊酚或丙泊酚复合瑞芬太尼用 于无痛纤维支气管镜检查的比较 [J]. 临床麻醉学杂志 , 2023, 39(10): 1050-1054.