听觉诱发电位指数监测老年人地氟醚麻醉深度  

Auditory evoked potentials index for monitoring the depth of desflurane anesthesia in the elderly

作　　者：蔡进[1] 郭曲练[1] 唐朝辉[1] 邹望远[1] 

机构地区：[1]中南大学湘雅医院麻醉科,长沙410008

出　　处：《中南大学学报（医学版）》2006年第1期100-103,共4页Journal of Central South University ：Medical Science

摘　　要：目的:观察老年人地氟醚麻醉中听觉诱发电位指数(AEP指数)和血流动力学的变化,评估AEP指数监测老年人地氟醚麻醉深度的应用价值。方法:选择ASA I^III级,择期全麻气管插管下手术患者40例,按年龄分为2组:老年组(年龄≥65岁,n=20)和中青年组(年龄18~55岁,n=20)。异丙酚、维库溴铵诱导气管插管后行控制呼吸,吸入地氟醚维持麻醉,调整吸入浓度,使地氟醚呼气末浓度依次维持在0.6 MAC,1.0 MAC和1.3 MAC,每一浓度均稳定20 m in。监测麻醉前(T1)、注射异丙酚后2 m in(T2)、气管插管时(T3)、气管插管后2 m in(T4)、地氟醚呼气末浓度为0.6MAC(T5),1.0MAC(T6)和1.3MAC(T7)时的平均动脉压、心率和AEP指数。结果:地氟醚麻醉期2组患者平均动脉压均比麻醉前明显下降(P<0.05),老年组心率与麻醉前相比亦显著减慢(P<0.05)。地氟醚呼气末浓度由0.6MAC^1.3MAC递增时,2组患者平均动脉压和心率无明显变化(P>0.05)。地氟醚麻醉期2组患者AEP指数与麻醉前相比显著降低(P<0.05),老年组地氟醚呼气末浓度在1.0MAC和1.3MAC时AEP指数较0.6 MAC时显著降低(P<0.05),但中青年组地氟醚呼气末浓度各浓度间AEP指数差异无统计学意义(P>0.05);在地氟醚各呼气末浓度时,老年组AEP指数均低于同时间点中青年组(P<0.05)。AEP指数与地氟醚呼气末浓度在老年组和中青年组的相关系数分别为-0.983和-0.980(P<0.05)。结论:听觉诱发电位指数与地氟醚呼气末浓度呈一定的剂量相关性,可监测老年人地氟醚麻醉深度变化并在一定程度上反映相同地氟醚呼气末浓度下老年人与中青年人麻醉深度的差异。Objective To observe the changes of auditory evoked potentials （AEP） index, mean arterial blood pressure （MAP） and heart rate （HR） undergoing desflurane anesthesia in the elderly and to evaluate the use of AEP index for monitoring the depth of desflurane anesthesia in the elderly. Methods Forty patients classified as ASA physical status Ⅰ-Ⅲ undergoing general anesthesia were divided into 2 groups with 20 patients in each group： Group elderly （≥65 years） and Group youth （18 -55 years）. Anesthesia was induced with propofol and vecuronium. After the endotracheal intubation, the lungs were ventilated with desflurane in oxygen. End-tidal concentration of desflurane was maintained at 0.6 MAC, 1.0 MAC and 1.3 MAC for 20 min,respectively. The changes of MAP, HR and AEP index were recorded simultaneously. Results During the anesthesia of desflurane, MAP decreased significant- ly compared with those at preanesthesia in both groups. And HR decreased significantly compared with those at preanesthesia only in Group elderly （ P 〈 0.05 ）. The changes of MAP and HR had no statistical difference with increasing end-tidal desflurane concentration from 0.6 MAC to 1.3 MAC in both groups （ P 〉 0.05 ）. During the anesthesia of desflurane, AEP index decreased significantly compared with those at preanesthesia in both groups （ P 〈 0.05 ）. In the periods of increasing concentration of desflurane,AEP index decreased gradually. In Group elderly, AEP index decreased significantly 1.0 MAC and 1.3 MAC of desflurane compared with those of 0.6MAC （P 〈 0.05）. In Group youth, the changes of AEP index had no statistical difference with increasing end-tidal desflurane concentration from 0.6 MAC to 1.3 MAC （P 〉 0.05）. At the same concentration of desflurane, AEP index in the Group elderly were less than those in Group youth （P 〈 0.05）. AEP index correlated with the end-tidal desflurane concentration significantly. The coefficient of product-moment correlation （r） were -0.983 and -0.

关 键 词：听觉诱发电位指数 麻醉深度 地氟醚 老年人 

分 类 号：R614.21[医药卫生—麻醉学]