脊柱侧凸矫正术患者听觉诱发电位指数与脑电双频谱指数的比较  

Comparison of Auditory Evoked Potential and Bispectral Index Devices with Standard Clinical Practice During Scoliosis Surgery

作　　者：赵秋华[1] 

机构地区：[1]北京市石景山医院麻醉科,100043

出　　处：《医学研究杂志》2008年第8期94-97,共4页Journal of Medical Research

摘　　要：目的七氟醚麻醉下脊柱侧凸矫正术中唤醒和术后恢复时脑电双频谱指数(BIS)和听觉诱发电位指数(AAI)快速鉴别意识存在和消失的比较。方法30例行脊柱侧凸矫正手术的成年病人,入室后行BIS和AEP等监测,全麻诱导后持续泵注雷米芬太尼0.3μg/(kg·min),吸入七氟醚。根据调节七氟醚吸入浓度方法的不同,将病人随机分为3组,其中对照组病人完全凭麻醉医生的临床经验调节七氟醚吸入浓度;AEP组根据AAI数值调节七氟醚吸入浓度;BIS组根据BIS数值调节七氟醚吸入浓度。唤醒试验开始时,停止吸入七氟醚,雷米芬太尼的输注速度降至0.05μg/(kg·min),唤醒试验完成后按上述方案继续维持麻醉。记录三组病人在清醒时(T0)、开放环路即刻(T1)、自主呼吸恢复时(T2)、唤醒时(T3)、拔除气管内导管时(T4)和定向力恢复时(T5)的AAI、BIS、呼气末七氟醚浓度,唤醒试验中自主呼吸恢复、唤醒以及拔除气管导管和定向力恢复时间等参数。结果与对照组比较,AEP组和BIS组在T1的AAI和BIS增加(P<0.05);与AEP组比较,BIS组在T5时的AAI升高(P<0.05)。BIS、AAI与呼气末七氟醚浓度呈负相关。与对照组比较,AEP组和BIS组的自主呼吸恢复、唤醒、拔管和定向力恢复时间缩短(P<0·05),呼气末七氟醚浓度在T1时降低(P<0.05)。讨论使用AEP监测和BIS监测均可预测脊柱侧弯矫正术病人的术中唤醒,区分清醒和麻醉状态。在预测无意识水平到清醒的转变方面,AAI要优于BIS,但从七氟醚麻醉状态苏醒后的AAI可能不如BIS稳定。Objective To investigate the discriminatory power of Auditory Evoked Potential and Bispectral Index devices on consciousness or consciousless state of patients during intraoperative wake-up test and recovery from scoliosis surgery with sevoflurane-remifentanil anesthesia. Methods Thirty ASA Class Ⅰ or Ⅱ adolescents undergoing scoliosis surgery under sevoflurane-remifentanil anes-thesia were randomly divided into three groups： standard clinical practice （control）, AEP-guided, and BIS -guided. After induction of general anesthesia remifentanil was infused at the rate of 0.3 μg/（ kg·min）. At the beginning of wake-up test, the circuit was opened while the vaporizer was turned off, and the rate of remifentanil infusion was decreased to 0.05 μg/（ kg·min）. Anesthesia was started again as soon as the patients had movements to command. The AAI, BIS, and end-tidal sevoflurane concentration at the time of before in- duction （T0）, circuit opened（T1） , spontaneously breathing recovered （T2） , patients movement to command （T3） , tracheal extubation （T4） and emergence from anesthesia （T5） , as well as the time of spontaneously breathing recovered, patients movement to command during wake-up test, tracheal extubation and emergence from anesthesia were recorded. Results Comparing with control group, AAI and BIS increased at T1 both in AEP-guided and BIS-guided group （P〈0.05）. Comparing with AEP-guided group, AAI increased at T5 in BIS-guided group （P〈0.05）. The end-tidal sevoflurane concentration was negatively correlated with both BIS and AAI. Comparing with control group, the time of spontaneously recovered breathing, patients movement to command, tracheal extubation and emergence from anesthesia were shorten significantly （P〈0. 05 ）, end-tidal sevoflurane concentration was decreased at T1 （P〈0.05）, in both AEP-guided and BIS-guided group. Conclusion Both AEP and BIS monitoring can predict patient movement to command and distin-guish or consciousless state in

关 键 词：诱发电位 听觉 脑电描记术 脊柱侧凸 

分 类 号：R614[医药卫生—麻醉学] R682.3[医药卫生—外科学]