全凭静脉麻醉的镇静程度与血流动力学及应激反应指标的相关性研究  

Correlations of degree of sedation with hemodynamics and stress reaction in total intravenous anesthesia

作　　者：陈学新[1] 马汉祥[2] 熊利泽[1] 孟尽海[2] 王建珍[2] 刘红[2] 施伟忠[2] 

机构地区：[1]第四军医大学西京医院麻醉科,陕西西安710033 [2]宁夏医学院附属医院麻醉科,宁夏银川750004

出　　处：《第四军医大学学报》2008年第1期29-32,共4页Journal of the Fourth Military Medical University

基　　金：宁夏回族自治区科委科技攻关项目(022-04)

摘　　要：目的:研究全凭静脉麻醉中镇静程度与血流动力学及应激反应指标之间的相关性.方法:选择ASAI～II级胃癌患者30例,行全凭静脉麻醉,监测脑电双频谱指数(BIS)、心率(HR)、血氧饱和度(SpO2),有创平均动脉压(MAP).时间点取值:入室平卧10min基础值(T1),诱导后气管插管前1min(T2),气管插管后3min(T3),手术切皮前1min(T4),切皮后3min(T5),麻醉诱导给药后1h(T6),拔管前1min(T7),清醒时(T8),并抽取动脉血测定丙泊酚血药浓度、肾上腺素(E)、去甲肾上腺素(NE)和β-内啡肽的含量.术中行麻醉深度控制(MAP±20%基础值和BIS值40～60).结果:麻醉后各指标较基础值明显降低(P<0.01),拔管前较基础值明显升高(P<0.01),大部分指标在清醒时较拔管前明显升高(P<0.01).血液浓度与BIS,MAP,HR,E,NE,β-内啡肽的总相关系数分别为-0.929,-0.336,-0.197,-0.648,-0.815,-0.752(P<0.01).BIS与MAP,E,NE,β-内啡肽的总相关系数分别为0.424,0.409,0.650,0.479(P<0.01).当血压和HR进行控制(或只控制血压),得出BIS与E,NE和β-内啡肽相关系数分别为0.347(0.334),0.572(0.571),0.362(0.36),P<0.01.结论:在麻醉深度监测中BIS不但可以反映患者的镇静程度而且可反映体内应激反应的程度.AIM： To study the correlations of degree of sedation with hemodynamics and stress reaction in total intravenous anesthesia （TIVA）. METHODS： Thirty ASA Ⅰ -Ⅱ patients with stomach cancer underwent bispectral index （BIS） monitoring, measurement of heart rate （ HR）, mean arterial blood pressure （MAP） and pulse oximetry （SpO2 ） at 10 min after entering operation room （ T1 ） , 1 min before intubation （ T2 ） , 3 min after intubation （ T3 ）, 1 min before incision （ T4 ）, 3 min after incision （ T5 ） , 1 h after induction of anesthesia （ T6 ） , 1 rain before extubation （T7 ） and awaking （T8 ）. BIS was measured continuously during this period as well as throughout the study and was recorded at different times. Plasma concentrations of propofol, epinephrine, norepinephrine and β-endorphine were determined at different times. RESULTS： All indexes post-anesthesia were lower significantly than the base values, and they at 1 min before extubation were higher as well. Almost indexes at awaking were higher than those at 1 min before extubation. The correlations between plasma propofol concentrations and BIS, MAP, HR, epinephrine, norepinephrine, β-endorphine were - 0. 929, - 0.336, - 0. 197, - 0. 648, - 0. 815, - 0. 752, respectively. The correlations between BIS and MAP, epinephrine, norepinephrine, β-endorphine were 0. 424, 0.409, 0. 650, 0. 479, respectively. The correlations between BIS and epinephrine, norepinephrine, β-endorphine were 0.347 （0. 334）, 0. 572 （0.571）, 0. 362 （0.36）, respectively when blood pressure and HR （or blood pressure only） were controlled during operation. CONCLUSION： BIS can not only monitor the degree of sedation butalso display stress reaction during TIVA.

关 键 词：麻醉 血流动力学 应激反应 全凭静脉麻醉 

分 类 号：R614[医药卫生—麻醉学]