吸入麻醉下不同P_(ET)CO_2对手术患者数量化脑电图及听觉诱发电位指数的影响  

Influence of different P_(ET)CO_2 on the quantitative EEG and auditory evoked potential hides during inhalation anesthesia

作　　者：孙永兴[1] 张雪松[2] 李萍[1] 宋晓丽[1] 张炳熙[1] 

机构地区：[1]首都医科大学附属北京同仁医院麻醉科,北京市100730 [2]佳木斯大学医学院附属第一医院麻醉科

出　　处：《中华麻醉学杂志》2005年第12期891-893,共3页Chinese Journal of Anesthesiology

摘　　要：目的研究吸入麻醉下不同呼气末二氧化碳分压(PETCO2)对患者数量化脑电图及听觉诱发电位指数的影响。方法 38例ASA Ⅰ或Ⅱ级择期手术患者,术中吸入异氟醚维持MAC 1．0,维库溴铵维持肌松,通过调节分钟通气量随机使PETCO2分别达到35、45、35、25、35 mm Hg,每个PETCO2水平稳定15 min,每次调整后10min采取足背动脉血进行血气分析,监测并记录数量化脑电图参数及听觉诱发电位指数的变化。结果与第一个PETCO2 35 mm Hg比较,在PETCO2 25 mm Hg期间,δ、θ、α、β波功率及BIS增加(P<0．05或0．01),95％SEF变化无统计学意义(P>0．05);在PETCO2 45 mm Hg期间,α波功率、β波功率、95％SEF及BIS降低(P<0．05),δ及θ波功率变化无统计学意义(P>0．05)。与 PETCO2 45 mm Hg比较,PETCO2 25 mm Hg期间δ、θ、α、β波功率及BIS增高(P<0．05或0．01)。δ比率、 MPF、及AAI在各期间均无明显改变(P>0．05)。结论PETCO2的改变可引起数量化脑电图参数的变化,但对听觉诱发电位指数无影响,在麻醉监测中应予以重视。Objective To investigate the effect of different end-tidal PCO2 （PET CO2 ） on the quantitative clectro-encephalogram （qEEG） and auditory evoked potential index （AAI） in patient undergoing elective general surgery under inhalation anesthesia. Methods Thirty-eight ASA Ⅰ-Ⅱ patients aged 22-48 yrs weighing 49-79 kg undergoing elective general surgery under inhalation anesthesia were studied. The intra-operative blood-loss was expected to be 〈 400 ml and duration of operation 〈 4 h. The patients were premedicated with intramuscular diazepam 10 mg. Anesthesia was induced with midazolam 0.05 mg·kg^-1 , fentanyl 2-4μg·kg^-1 , propofol 1.0 mg·kg^-1 and vecuronium 0.1 mg·kg^-1 . The patients wezre mechanically ventilated after tracheal intubation. Anesthesia was maintained with isoilurane inhalation at 1.0 MAC and intermittent IV boluses of vecuronium. AAI, qEEG, BIS, 95% SEF, ECG, BP, SpO2, PETCO2, end-tidal isoflurane concentration and naso-pharyngeal TO were continuously monitored. PETCO2 was changed in the following order： 35 mm Hg→45 mm Hg→35 mm Hg→25 mm Hg→35 mm Hg by adjusting the minute ventilation. Each PETCO2 was maintained for 15 min.Results Low PETCO2 （25 mm Hg） caused significant increase in the potential of the delta, theta, alpha and beta waves （P 〈 0.05 or 0.01 ） as compared with normal PETCO2 （35 mm Hg） and BIS also increased from 50 to 56 （ P 〈 0.05） while 95% SEF was unaltered. In contrast high PETCO2 （45 mmHg） caused significant decrease in the potential of alpha and beta waves （ P 〈 0.01 ） whereas the potential of delta and theta waves remained unchanged compared with normal PETCO2 （35 mm Hg）. 95% SEF was also decreased from 10.7→7.6 （P 〈0.05） and BIS from 50→46 （P 〈 0.05） when PETCO2 increased from 35 mm Hg to 45 mm Hg. Delta ratio, median frequency and AAI were not significantly changed when PETCO2 was increased or decreased. Conclusion Variations in PETCO2 between the range of 25-45 mm Hg produce significant changes

关 键 词：二氧化碳 麻醉 吸入 脑电描记术 诱发电位 听觉 

分 类 号：R614[医药卫生—麻醉学] R614.2[医药卫生—外科学]