异丙酚和异氟醚对全麻手术病人脑干听觉诱发电位影响的比较  

Effects of propofol versus isoflurane on braiustem auditory evoked potential

作　　者：杨涛[1] 魏绪红[2] 李玉娟[1] 彭书岐[1] 

机构地区：[1]中山大学附属第二医院麻醉科,广州市510120 [2]本大学中山医学院生理学教研室疼痛研究中心

出　　处：《中华麻醉学杂志》2010年第6期644-647,共4页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金（30700787）;广东省科技计划社会发展项目（20098030801143）

摘　　要：目的 比较异丙酚和异氟醚对全麻手术病人脑干听觉诱发电位（BAEP）的影响.方法 择期拟行全麻手术的病人30例,年龄20～50岁,体重44～75 kg,ASA分级Ⅰ或Ⅱ级,随机分为2组（n=15）：异丙酚组（P组）和异氟醚组（I组）.监测SpO2、PETCO2、BAEP和BIS.麻醉诱导：P组靶控输注异丙酚,血浆靶浓度6μg/kg,I组吸入3%异氟醚,两组静脉注射维库溴铵0.1 mg/kg,气管插管后行机械通气,维持PETCO235～40 mm Hg,SpO298%～100%.P组靶控输注异丙酚,I组吸入异氟醚维持麻醉.分别于麻醉诱导前（T0）、气管插管后BIS达70并维持5 min（T1）和BIS达50并维持5 min（T2）时,记录Ⅰ波、Ⅲ波、Ⅴ波的潜伏期、Ⅰ-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ的峰间期.结果 P组Ⅰ波、Ⅲ波、Ⅴ波的潜伏期和Ⅰ-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ的峰间期组内比较差异无统计学意义（P＞0.05）;与T0时比较,I组T1时Ⅰ波、Ⅲ波、Ⅴ波的潜伏期和Ⅰ-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ的峰间期差异无统计学意义（P＞0.05）,T2时Ⅲ波、Ⅴ波的潜伏期和Ⅰ-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ的峰间期延长（P＜0.05或0.01）;与T1时比较,I组T2时Ⅲ波、Ⅴ波的潜伏期和Ⅰ-Ⅲ、Ⅰ-Ⅴ的峰间期延长（P＜0.05或0.01）;与P组比较,I组T2时Ⅴ波潜伏期和Ⅰ-Ⅴ峰间期延长（P＜0.05）.结论 与异氟醚相比,等效剂量的异丙酚对全麻手术病人BAEP的影响更小,提示其对脑干功能的抑制作用更小.Objective To compare the effects of propofol versus isoflurane on brainstem auditory evoked potential （BAEP） and explore the difference in the effects of the two anesthetics on the brainstem. Methods Thirty ASA Ⅰ or Ⅱ patients aged 20-50 yr without heating disorder, scheduled for elective surgery performed under general anesthesia were randomly divided into 2 groups （n = 15 each）： propofol group （group P） and isoflurane group （group Ⅰ）. SpO2, PET CO2, BIS and BAEP were continuously monitored before and during anesthesia. Anesthesia was induced by propofol administered by TCI or isoflurane inhalation. Tracheal intubation was facilitated with vecuronium. The patients were mechanically ventilated. PET CO2 was maintained at 35-40 mm Hg and SpO2 at 98%-100%. After intubation BIS was maintained at 70 and 50 respectively ,the latency of the wave Ⅰ , Ⅱ and Ⅴ and the inter-peak latency （IPL） betwecn wave Ⅰ -Ⅲ , Ⅲ-Ⅴ and Ⅰ -Ⅴ were recorded.Results In group P there was no significant difference in the latency of the wave Ⅰ , Ⅲ and Ⅴ and the IPL between wave Ⅰ - Ⅲ , Ⅲ - Ⅴ and Ⅰ - Ⅴ between the baseline before anesthesia and at BIS 70 and 50. In group Ⅰ the latency of wave Ⅲ and Ⅴ and the IPL between wave Ⅰ - Ⅲ , Ⅲ - Ⅴ and Ⅰ - Ⅴ were significantly longer at BIS 50 than the baseline before anesthesia, while the latency of wave Ⅲ and Ⅴ and the IPL between wave Ⅰ -Ⅲ andⅠ -Ⅴ at BIS 50 were significantly longer than that at BIS 70. At BIS 50 the latency of wave Ⅴ and the IPL between wave Ⅰ -Ⅴ were significantly longer in group Ⅰ than in group P. Conclusion At comparable depth of anesthesia propofol exerts less depressant effects on BAEP indicating less depression of brainstem.

关 键 词：二异丙酚 异氟醚 诱发电位 听觉 脑干 脑电描记术 

分 类 号：R614[医药卫生—麻醉学]