摘要： 目的  评价神经外科术中唤醒麻醉患者术后神经心理功能与生活质量。方法  回顾调查81 例于唤醒麻醉条件下行脑胶质瘤切除术且随访资料完整患者的临床资料，依据年龄、性别、文化程度、肿瘤位置和特征，以1∶1 配对选择同期于非唤醒麻醉状态下行脑胶质瘤切除术患者作为对照组，通过电话随访了解患者术后神经功能及心理状况，采用36 条目简明健康调查表评价患者生活质量。结果  完成全部调查研究的唤醒麻醉组和非唤醒麻醉组患者各73 例，唤醒麻醉组21 例存在术后神经功能缺损症状与体征，12 例术后出现心理异常，30 例存在术中知晓；而非唤醒麻醉组患者28 例术后出现神经功能缺损，8例存在心理异常，无一例患者存在术中知晓。唤醒麻醉组术后远期（> 6 个月）神经功能评价仅9 例仍存在神经功能缺损症状与体征，少于非唤醒麻醉组的18 例（P = 0.038）；术后初期、中期和远期神经功能评价，两组患者生活质量评分差异无统计学意义（均P > 0.05）。结论  神经外科术中唤醒麻醉脑胶质瘤切除术是切除位于或邻近脑功能区肿瘤的主要手术方式，可以减少术后远期神经功能缺损发生率，适当的麻醉管理不会造成患者创伤后心理障碍，亦不影响其术后生活质量。

关键词: 麻醉, 静脉； 清醒镇静； 神经胶质瘤神经心理学测验； 神经外科手术； 手术后并发症

Abstract: Objective To assess the neuropsychological function and quality of life of the patients after awake craniotomy (AC). Methods A case-control study was conducted among 81 patients who underwent awake craniotomy, and a 1-to-1 control group (matched by age, gender, degree of education, tumor location and characteristic) undergoing general anesthesia (GA) in glioma resections was assembled. The incidence of postoperative neurological deficits, psychological disorders and recurrence were investigated during telephone follow-ups, and Medical Outcomes Study Short Form 36 (SF-36) was adopted to evaluate the life quality of patients. Results Almost 73 pairs of patients fulfilled the survey of AC and GA group respectively. There were 21 patients and 28 patients with postoperative neurological deficits, and 12 patients and 8 patients with psychological disorders in AC and GA group respectively. Thirty patients of AC group had the recollection of being awake during the surgery. There were 9 patients in CA group having long-term ( > 6 months) neurological deficits, which was less than the number of GA group (18 patients, P = 0.038). According to the assessment in short-term, medium-term and long-term postoperative neurological deficits, there was no significant difference in the quality-of-life scores between the two groups (P > 0.05, for all). Conclusion Awake craniotomy can be the main method for removing the lesions located in or close to functional areas with lower incidence of long?term postoperative neurological deficits, and it has no significant impact on the psychological status and the quality of life postoperatively．

Key words: Anesthesia, intravenous, Conscious sedation, Glioma, Neuropsychological tests, Neurosurgical procedures, Postoperative complications