脑电双频谱指数联合听觉诱发电位指数调控麻醉深度对应激反应的影响  

The impact of BIS and AAI attenuate depth of anesthesia on the stress response

作　　者：李传耀[1] 康芳[1] 马骏[1] 王瑞婷[1] 

机构地区：[1]安徽医科大学附属省立医院,安徽省立医院麻醉科,合肥230001

出　　处：《中国临床保健杂志》2013年第4期342-345,共4页Chinese Journal of Clinical Healthcare

基　　金：安徽省卫生厅青年基金(09B126)

摘　　要：目的观察全凭静脉麻醉时以脑电双频谱指数(BIS)及听觉诱发电位指数(AAI)联合调控麻醉深度与患者应激反应指标变化的关系。方法选择拟在气管内麻醉下行择期胃大部切除手术的成年患者40例,ASA分级Ⅰ～Ⅱ级,随机分为对照组(C组,n=20)和麻醉深度调控组(M组,n=20)。所有患者均采用全凭静脉麻醉。麻醉深度控制目标:C组为维持患者血压和心率波动在各自基础值的±20%之内,M组维持AAI.值15～30、BIS值40～55。于麻醉前(T0)、气管插管后(T1)、切皮时(T2)、胃肠吻合时(T3)、关腹前(T4),气管拔管后(T5)分别记录患者心率(HR)、平均动脉压(MAP)、BIS、AAI值并抽取桡动脉血测定血糖、皮质醇水平。记录术中患者有无体动反应、手术时间、患者术后苏醒时间、拔管时间、术中血管活性药使用情况及术后有无术中知晓及其他麻醉并发症。结果 M组苏醒时间、拔管时间缩短,血管活性药使用多(P<0.05)。C组切皮时血压、心率升高(P<0.05)。C组血糖T2、T3时与基础值及M组比较差异有统计学意义(P<0.05);皮质醇T2、T3、T4、T5时与基础值及M组比较差异有统计学意义(P<0.05)。C组有1例患者发生术中知晓。结论 BIS、AAI与麻醉深度及应激反应指标之间有良好相关性,联合监测能指导麻醉深度调控,减少过度应激。Objective To evaluate the impact of BIS and AAI attenuate the depth of anesthesia on the stress response in general anesthesia.Methods Forty ASA Ⅰor Ⅱ adult patients underwent gastrectomy surgery using total intravenous anesthesia were randomly assigned to two groups,the control group（C） and the the monitoring group（M）.In group C,the depth of anesthesia was to keep blood pressure and heart rate in no more than ± 20% of their basic value.And in group M,the aim was to maintain the AAI 15 ～ 30 and BIS 40 ～ 55.MAP,HR,SpO2,the BIS and AAI were recorded on several points.The blood glucose and cortisol were detected at the same time.The OAA / S scale score and intraoperative awareness were assessed after surgery.Results The MAP and HR of the control group rose on time of skin incision（P 0.05）.The BIS and AAI in group C were higher than those in group M during the operation（P 0.05）.The blood glucose and cortisol of group C were higher than those in group M during the operation（P 0.05）.The recovery time of group M were shorter than group C.There was one patient in group C occurred intraoperative awareness.Conclusions Attenuating depth of anesthesia according to BIS and AAI could shorten the recovery time,avoid intraoperative awareness,reduce the excessive stress response and improve the quality of anesthesia.

关 键 词：麻醉 静脉 诱发电位 听觉 脑电描记术 应激 

分 类 号：R614.24[医药卫生—麻醉学]