维库溴铵对全麻患者脑电熵指数和脑电双频谱指数监测镇静深度的影响  

Effects of vecuroniurn on entropy and bispectral index monitoring

作　　者：陶国荣[1] 宋小星[1] 任瑜[1] 彭章龙[1] 于布为[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院麻醉科,200025

出　　处：《中华麻醉学杂志》2007年第3期240-243,共4页Chinese Journal of Anesthesiology

摘　　要：目的观察全身麻醉过程中,维库溴铵对脑电熵指数——状态熵（AE）和反应熵（RE）以及脑电双频谱指数（BIS）的影响。方法ASAⅠ级或Ⅱ级择期手术患者60例,随机分为4组（n=15）：Ⅰ组为对照组,静脉注射生理盐水;Ⅱ组、Ⅲ组、Ⅳ组为试验组,分别静脉注射维库溴铵0．03、0．06、0．12 mg/kg。麻醉诱导采用异丙酚靶控输注（TCI）,当效应室浓度（CE）达到3．5μg/ml时,按组别静脉注射维库溴铵或等容积生理盐水,5 min后静脉注射芬太尼3μg/kg,行气管插管,观察5 min后将Ⅰ组、Ⅱ组、Ⅲ组维库溴铵剂量补足到0．12 mg/kg。记录诱导前即刻、CE达到3．5μg/ml、注射维库溴铵或生理盐水后1、2、3、4、5 min、气管插管前即刻、插管后即刻及插管后1、3、5 min的RE、AE、BIS、HR和MAP。结果与维库溴铵静脉注射前即刻比较,4组静脉注射后各时点RE、SE、BIS、HR、MAP差异无统计学意义（P＞0．05）;4组间静脉注射前后RE、SE、BIS、HR、MAP比较差异无统计学意义（P＞0．05）。与插管前即刻比较,4组插管后即刻及插管后1min时RE、SE、BIS、HR和MAP均升高（P＜0．05或0．01）;与Ⅰ组比较,Ⅱ组、Ⅲ组、Ⅳ组插管后即刻和插管后1 min RE、SE和BIS降低（P＜0．05）,但3组间比较差异无统计学意义（P＞0．05）。结论在深度镇静且无伤害性刺激时,维库溴铵对脑电熵指数和BIS无影响;存在伤害性刺激时（如气管插管）,即使小剂量（0．03 mg/kg）的维库溴铵也可降低脑电熵指数和BIS的升高幅度。Objective To investigate if muscle relaxation can affect BIS and entropy monitoring of hypnotic level during propofol anesthesia. Methods Sixty ASA Ⅰ or Ⅱ patients aged 22-64 yr, weighing 47-75 kg undergoing elective surgery under general anesthesia were enroUed in this study. Operation on the head was excluded. The patients were unpremedicated. State entropy （SE）, response entropy （RE） （S/5^TM Entropy Datex Ohmeda Co Finland）, BIS （S/5TM Datex-Ohmeda Co Finland）, ECG, MAP, HR and SpO2 were monitored before and during anesthesia. Anesthesia was induced with TCI of propofol. The target effect-site concentration （CE）was set at 3.5μg/ml . The patients were randomly divided into 4 groups according to the dose of vecuronium： group 1 received normal saline 4 ml and group Ⅱ , Ⅲ, Ⅳ received vecuronium 0.03, 0.06 and 0.12 mg/kg respectively. Fentanyl 3 μg/kg was given at 5 min after vecuronium administration. The patients were then intubated. Five minutes after intubation supplementary vecuronium was given intravenously to make total vecuronium dose reach 0.12 mg/kg in group Ⅰ , Ⅱ and Ⅲ SE, RE and BIS values were recorded before anesthesia （baseline）, when CE reached 3.5μg/ml, at 1, 2, 3, 4, 5 min after vecuronium injection, at intubation and at 1, 3, 5 min after intubation. Results SE, RE, BIS, MAP and HR did not change significantly after vecuronium in all patients. However tracheal intubation significantly increased SE, RE, BIS, MAP and HR in all patients （P 〈 0.05 or 0.01 ）. SE, RE and BIS values were significantly higher at intubation and 1 min after intubation in group Ⅰ than in the other 3 groups （ P 〈 0.05）, but there was no significant different among group Ⅱ , Ⅲ and Ⅳ. Conclusion Vecuronium does not change the SE, RE and BIS values in patients deeply sedated without noxious stimulation. Vecuronium even a relatively small dose （0.03 mg/kg ） can reduce the degree of increase in SE, RE and BIS values induced by noxious stimulation such as tracheal

关 键 词：脑电描记术 雄甾烷醇类 麻醉 全身 清醒镇静 

分 类 号：R686[医药卫生—骨科学]