清醒或七氟醚麻醉下瑞芬太尼靶控输注对听觉诱发电位指数的影响  

Effects of Target-Controlled Infusion of Remifentanil on the A-line AEP Index during Awake State or Sevoflurane Anesthesia

作　　者：焦静[1] 黄绍强[1] 

机构地区：[1]复旦大学附属妇产科医院麻醉科,上海200011

出　　处：《中国临床医学》2009年第3期437-439,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:观察清醒状态及七氟醚麻醉下瑞芬太尼靶控输注(TCI)对听觉诱发电位指数(AAI)的影响。方法:28例择期全麻手术病例,根据瑞芬太尼靶控效应室浓度(CeREM)设定的不同均分为A组与B组。记录用药前安静时(T1)、CeREM达到2ng·mL-15min后(A组T2)或4ng·mL-15min后(B组T2)的AAI、心率(HR)、平均动脉压(MAP)、动脉血氧饱和度(SpO2)、呼气末二氧化碳浓度(PetCO2)值;然后以瑞芬太尼、丙泊酚、维库溴胺麻醉诱导,气管插管后停瑞芬太尼改吸七氟醚,呼气末七氟醚浓度达到1.4%20min后(T3)联合瑞芬太尼TCI,记录CeREM达到2ng·mL-15min后(A组T4)或4ng·mL-15min后(B组T4)的AAI值。结果:T2时所有患者都保持清醒,AAI不随CeREM的增加而改变,HR、MAP的变化也不明显,但SpO2在B组T2时明显下降(P<0.05),PetCO2在两组均升高,且B组比A组升高更显著(P<0.05);七氟醚麻醉下T4时两组AAI值均明显降低(P<0.05),且B组比A组降低更显著(P<0.05)。HR和MAP也都明显下降(P<0.05),HR值B组比A组降低更显著(P<0.05),而MAP两组间差异无显著性。结论:单纯瑞芬太尼TCI对AAI无明显影响,即使增加靶浓度至呼吸受到明显抑制的程度,AAI也不会降低;而七氟醚麻醉时,联合瑞芬太尼TCI可引起AAI明显下降,降低的程度与CeREM大小有关。Objective：To investigate the effects of target-controlled infusion （TCI） of remifentanil on the A-line Auditory Evoked Potential index （AAI） during the awake state or sevoflurane anesthesia. Methods： Twenty-eight patients scheduled for gynecological surgery by general anesthesia were randomly allocated to one of two groups according to remifentanil effect-compartment concentration （CeREM） （14 per group）. A-Line ARx index（AAI）, heart rate（HR）, mean arterial pressure（MAP, pulse oximetry （SpO2）,forend-trdal carbon dioxide pressure（PetCO2 ）were recorded before TCI remifentanil （T1）, after CeR- EM maintained at 2 ng. mL^-1 for5 min （T2 of group A） or 4 ng·mL^-1 for5 min （T2 of group B）. Then anesthesia was induced with remifentanil, propofol and vecuronium. After tracheal intubation, TCI remifentanil was stoped and anesthesia was maintained with an end-tidal sevoflurane concentration （FetSEV） of 1.4% for 20 min （T3）. Then TCI remifentanil was combined with inhaling sevoflurane, and AAI was recorded after CeREM at 2 ng · mL^-1 for 5 min （T4 of group A） or 4 ng· mL^-1 for 5 min （T4 of group B）. Results： All patients kept awake at T2 and AAI did not change after increasing CeREM. The changes of HR and MAP were also insignificant, but SpO2 was declined and PetCO2 was increased obviously at T2 in group B （P〈0.05）. AAI values of the two groups at T4 were both lower than those at T3 （P〈0.05）, and the decline of AAI in group B was more obvious than that in group A （P〈0.05）. HR and MAP of both groups were also decreased obviously （P〈0.05）. The decline of HR in group B was more obvious than that in group A, but no significant difference in MAP was observed between group A and B. Conclusion：Just TCI remifentanil had no effect on AAI, and AAI did not change even when respiration of the patient was suppressed by increasing CeREM. But it would be declined when sevoflurance anesthesia was combined with TCI remifentanil, and the declined

关 键 词：瑞芬太尼 听觉诱发电位指数 清醒 七氟醚 靶控输注 

分 类 号：R971[医药卫生—药品]