异氟醚-异丙酚吸静复合全麻下麻醉深度和异丙酚血药浓度的监测  

Monitoring on depth of anesthesia and determination of true blood Propofol concentration in patients with inhalation of Isoflurane and TCI of Propofol

作　　者：杨浩波[1] 郭曲练[1] 

机构地区：[1]中南大学湘雅医院麻醉科,湖南长沙410008

出　　处：《中国现代医学杂志》2008年第14期2042-2045,共4页China Journal of Modern Medicine

基　　金：湖南省卫生厅基金项目(No:B2007013)

摘　　要：目的观察异氟醚和异丙酚吸静复合全麻下听觉诱发电位指数(AEP index)的变化,监测异丙酚的实际血药浓度,探讨异氟醚吸入和异丙酚靶控输注(TCI)复合全麻中麻醉深度监测的应用及其意义。方法ASAⅠ～Ⅱ级,择期行腹部外科手术的患者20例。异丙酚和维库溴铵诱导气管内插管后,吸入异氟醚,呼末浓度为1.0MAC,稳定20min后靶控输注异丙酚,靶浓度从1.0μg/mL开始,以0.5μg/mL递增,靶浓度稳定在3.0μg/mL开始手术。记录MAP、HR和AAI。异丙酚各TCI时点采动脉血测定实际血浆浓度。结果患者MAP和HR的变化与异丙酚浓度无相关性。AAI与异丙酚靶控浓度的相关系数为-0.923(P<0.001)。AAI与插管刺激的相关性为-0.728(P<0.01),AAI与切皮和探查的的刺激无线性相关。异丙酚各靶控浓度与对应的实际血药浓度之间有良好的相关性(r=0.951)。结论听觉诱发电位指数是监测异氟醚-异丙酚复合麻醉深度的可靠指标,能有效的反应气管插管的刺激,但不能有效地监测切皮和探查时的心血管反应。异丙酚靶控输注时的预测血药浓度能够较好地反应实际血药浓度。[Objective] To evaluate the effects of monitoring on the depth of anesthesia in patients with inhalation of Isoflurane and TCI of Propofol by observing the changes of AEP index and determination of the true blood Propofol concentration. [Methods] 20 ASA physical status Ⅰ-Ⅱpatients undergoing selective abdominal opera- tions. Anesthesia was induced with Poprofol and Vecuronium. After tracheal intubation, the patients were ventilated with 1.0 MAC Isoflurane in pure oxygen, and after 20 minutes, Propofol was administered with TCI according to the different target plasma concentration from 1.0 μg/mL to 3.0 μg/mL （increased 0.5 μg/mL every time）. The changes of mean arterial pressure （MAP）, heart rate （HR） and AEP index were recorded simultaneously. Blood samples were taken from radial artery for determination of blood Propofol concentration at the time points of different target plasma concentration of Propofol. [Results] There was no close correlation between both MAP and HR and the target plas- ma concentration of Propofol. The coefficient of correlation between AAI and the target plasma concentration of propofol was -0.923 （P 〈0.001）. The coefficient of correlation between AAI and the stimulation of endotracheal in- tubation was -0.728 （P 〈0.001）, however, There was no close correlation between AAI and the stimulation of skin incision and exploration. There was a very high correlation between the target plasma concentration and the mea- sured blood concentration, the coefficient of correlation between both concentrations was r --0.951 （P 〈0.001）.[Conclusion] AEP index is the reliable parameters to monitor the depth of anesthesia with Isoflurane and Propofol, and in response to the stimulation of tracheal intubation too, AEP index can not be used to predict the cardiovascu- lar reaction of skin incision and exploration. The target plasma concentration can be used to indicate the true blood Propofol concentration.

关 键 词：异氟醚 二异丙酚 麻醉深度 听觉诱发电位指数 

分 类 号：R614.27[医药卫生—麻醉学]