颅脑手术病人不同麻醉深度监测方法的比较  

Comparison of three techniques monitoring depth of anesthesia during brain surgery

作　　者：刘晓媛[1] 彭宇明[1] 王保国[1] 

机构地区：[1]中国医学科学院首都医科大学附属北京天坛医院麻醉科,北京市100050

出　　处：《中华麻醉学杂志》2005年第5期330-333,共4页Chinese Journal of Anesthesiology

摘　　要：目的观察颅脑手术病人应用异丙酚镇静、芬太尼镇痛及异氟烷麻醉过程中脑电双频谱指数(BIS)、听觉诱发电位指数(AEPI)及电刺激-循环反应的变化及其在全麻深度监测中的价值。方法择期行颅脑手术病人20例,持续输注异丙酚0.25mg·kg-1·min-1,当异丙酚剂量达5mg/kg时停止输注。静脉注射芬太尼2μg/kg行气管插管,异氟烷维持麻醉。分别于异丙酚剂量达2.5、3.0、3.5、4.0、4.5、5.0mg/kg、静脉注射芬太尼后2min及呼气末异氟烷浓度稳定于0.7、1.0、1.3MAC时给予病人一次强直电刺激(ETS)。记录ETS前后BIS、AEPI及循环反应的变化[包括血压、心率(HR)变化幅度(△SP、△DP、△HR)及其恢复50%、90%的时间(TBP50%、TBP90%、THR50%、THR90%)]。结果BIS、AEPI与镇静程度呈正相关。ETS后BIS、AEPI变化不明显,但SP、DP、HR高于ETS前(P<0.01)。随异丙酚剂量和异氟烷浓度的增加,△SP和△HR逐渐变小,TBP50%、TBP90%、THR50%、THR90%逐渐缩短(P<0.01)。结论BIS、AEPI与镇静深度有较好的相关性,但不能反映镇痛;强直电刺激-循环反应的幅度可以反映镇痛,其中以△SP最直观。Objective To evaluate the performance of bispectral index (BIS),auditory evoked potential index (AEPI) and cardiovascular response to electrical tetanus stimulus (ETS) for monitoring depth of sedation induced by propofol , analgesia produced by fenanyl and depth of isoflurane anesthesia. Methods Twenty ASA Ⅰ or Ⅱ patients of both sexes (11 males,9 females) aged 18-56 yr, weighing 50-80 kg undergoing elective brain surgery were studied. The patients were unpremedicated. The baseline BIS, AEPI, BP(SP, DP) and HR were measured before anesthesia. Propofol was infused at 0.25 mg·kg-1·min-1 and the infusion was stopped when the total amount of propofol infused reached 5 mg·kg-1 at the end of 20 min infusion. Fentanyl 2 μg·kg-1 was then given i.v. Three minutes later the patients were intubated and mechanically ventilated. Tracheal intubation was facilitated by vecuronium 0.1 mg·kg-1. Anesthesia was maintained with isoflurane. Depth of sedation was measured using OAA/S scale during propofol infusion. ETS was given at the following time points: when the amount of propofol infused reached 2.5, 3.0, 3.5, 4.0, 4.5, 5.0 mg·kg-1,2 min after fentanyl administration and at 0.7, 1.0, 1.3 MAC isoflurane (end-tidal isoflurane concentration). BIS and AEPI values before and after ETS and changes in BP and HR (ABP, AHR) after ETS and the time for BP and HR to return to the pre-ETS value in 50% and 90% of the patients (TBP50%,TBP90%,THR50%,THR90% ) were recorded. Results BIS and AEPI were positively correlated with sedation depth. There were no significant changes in BIS and AEPI after ETS, but SP, DP and HR increased significantly after ETS( P < 0.01). With increasing doses of propofol and increasing isoflurane concentration △BP and △HR induced by ETS became smaller and TBP50%,TBP90%,THR50%,THR90% shorter. Conclusion Both BIS and AEP correlate well with OAA/S scores and can be used to evaluate the depth of sedation and anesthesia brain surgery. The cardiovascular response to ETS(△BP and △HR) can indicate the intens

关 键 词：颅脑手术病人 监测方法 麻醉深度 听觉诱发电位指数 脑电双频谱指数 强直电刺激 循环反应 心率(HR) 静脉注射 异丙酚镇静 异氟烷 BIS 芬太尼 ETS 麻醉过程 深度监测 持续输注 气管插管 维持麻醉 镇静程度 镇静深度 SP 镇痛 

分 类 号：R614[医药卫生—麻醉学]