听觉诱发电位指数调控老年人靶控输注丙泊酚麻醉的研究  

Propofol anaesthesia with target controlled-infusion technic modulated by auditory evoked potential index in the elderly

作　　者：杨华凌[1] 林财珠[1] 方舒东[1] 

机构地区：[1]福建医科大学附属第一医院麻醉科,福州市350005

出　　处：《临床麻醉学杂志》2003年第12期715-718,共4页Journal of Clinical Anesthesiology

基　　金：福建省卫生厅创新课题 ( 0 1A0 89)

摘　　要：目的　研究听觉诱发电位指数 (AEPI)调控持续靶控输注 (TCI)丙泊酚在老年人麻醉中的可行性。方法　 30例ASAⅠ～Ⅱ级择期胃切除手术的病人分为老年组 (>6 5岁 ,Ⅰ组 )和中青年组 (2 0～ 5 9岁 ,Ⅱ组 ) ,每组 15例。诱导前静注芬太尼 2 μg/kg。丙泊酚的靶效应室浓度设定为3 5 μg/ml。两组丙泊酚效应室浓度均根据AEPI调整 ,使麻醉深度控制在 :插管时 35～ 4 5 ,切皮时2 0～ 30 ,探查时 15～ 2 5 ,关腹时为 2 5～ 35。在 8个时间点监测并记录心率 (HR)、收缩压 (SBP)、舒张压 (DBP)、平均动脉压 (MAP)、AEPI、丙泊酚的总量和麻醉时间。结果　两组病人平均丙泊酚标准化剂量 :Ⅰ组为 10 6 4 3μg·kg 1·min 1、Ⅱ组为 12 3 6 1μg·kg 1·min 1。两组插管前时SBP、DBP、MAP同基础值相比都没有显著变化 ,但插管后 5min时与基础值比较 ,血液动力学下降在老年人中较为显著(P <0 0 5 ) ,而中青年人的较为稳定。在术中探查时其血液动力学都有所回升 (P <0 0 5 ) ,停药时、睁眼时及拔管时与基础值比较 ,血液动力学无显著变化。结论　以AEPI调控持续靶控输注丙泊酚在对老年人麻醉是可行的 ,可保持血液动力学相对稳定 ,减少老年人麻醉用药量。Objective To study the feasibility of auditory evoked potential index used in the target controlled-infusion(TCI) of propofol general anesthesia in the elderly patients.Methods Thirty ASA physical status of Ⅰ-Ⅱ patients with normal hearing undergoing selective surgery were divided into two groups with 15 cases each:The patients in the elderly group (group Ⅰ) were greater than 65 years old,and in the younger 20-50 years old(group Ⅱ).A bolus of 2 μg/kg fentanyl was given Ⅳ before induction and target concentration of propofol was set at 3.5 μg/ml before induction and modulated according to the auditory evoked potential index (AEPI).The changes of HR,SBP,DBP,MAP,real time AEPI,total dose of propofol and the anaesthesia duration of time were recorded.Results The standardized unit dose of propfol of the elderly group was significantly lower than that of the younger.During anaesthesia,SBP,DBP and MAP had no significant changes after inubution compared to the baseline in both groups.But at 5 min after intubution,the hemodynamics was significantly lower than the baseline in the elderly group(P<0.05).While the changes was not significantly in the younger.During surgical exploration,the hemodynamics increased in both groups(P<0.05).At the time points of discontinuation of infusion,opening the eyes and extubution,the hemodynamics was stable.Conclusions Target controlled-infusion of propofol general anesthesia modulated by auditory evoked potential index in the elderly is feasible with the advantages of keeping stable hemodynamis and saving anesthatics.

关 键 词：老年人 听觉诱发电位指数 靶控输注 丙泊酚 调控 全麻深度 麻醉 

分 类 号：R614[医药卫生—麻醉学]