BIS联合AAI指导妇科腔镜手术麻醉深度调控的临床研究  

Clinical observation on depth of anesthesia regulated by BIS and AAI in laparoscopic gynecologic surgery

作　　者：康芳[1] 李娟[1] 柴小青[1] 王松[1] 

机构地区：[1]安徽医科大学附属省立医院麻醉科,合肥市230001

出　　处：《临床麻醉学杂志》2013年第9期850-852,共3页Journal of Clinical Anesthesiology

基　　金：安徽省卫生厅青年基金(09B126)

摘　　要：目的评价脑电双频指数（BIS）联合听觉诱发电位指数（AAI）指导妇科腔镜手术全麻深度对应激反应的影响。方法择期行妇科腔镜手术患者200例，ASAⅠ或Ⅱ级，随机数字表法均分为BIS组（B组）、AAI组（A组）、BIS-5-AAI组（BA组）和对照组（C组）。麻醉深度：B组BIS为40～55；A组AAI为15-25；BA组BIS为40-55、AAI为15-25；C组为有创血压和心率波动范围不超过基础值±20％。记录丙泊酚用量及去氧肾上腺素、尼卡地平和艾司洛尔用量、喉罩拔出时间、完全清醒时间，并于入室后5min（T0）、气腹后1min（T1）、3min（T2）、分离病变组织（T3）时，缝皮结束时（T4）抽取动脉血，测定血糖（Glu）、β内啡肽（β-EP）和肾上腺素（E）的浓度。结果与T0时比较，T1～T4时四组患者Glu、β-EP及E浓度均明显升高（P〈0．05）。与B组比较，T1、T2和T4时A组、BA组和C组Glu、β-EP及E浓度明显降低（P〈0．05）、丙泊酚用量明显增加、苏醒时间明显延长（P〈0．05）。与BA组比较，T1、T2和T4时A组和C组Glu β-EP及E浓度明显升高（P〈0．05），B组和A组去氧肾上腺素用量明显减少、A组尼卡地平和艾司洛尔用量明显增加（P〈0．05）。与A组比较，B组去氧肾上腺素用量明显减少、尼卡地平和艾司洛尔用量明显增加（P〈0．05）。结论BIS联合AAI监测更有利于及时合理调控麻醉深度，降低应激反应。Objective To investigate the value of the BIS and AAI in regulating tee depth of anesthesia and stress in the laparoseopic gynecologic surgery. Methods Two hundred patients undergoing selected laparoscopic gynecologic surgery were enrolled and divided into four groups randomly. Each group included 50 patients. The depth of anesthesia was regulated by different index. Group B is to keep the BIS at 40 55. Group A is to keep the AAI at 15-25. Group BA is to keep the BIS at 40-55 and AAI at 15-25. Group C is to control the variability of blood pressure and the heart rate within 20% of basic level. The duration of anesthesia, the dose of propofol, the time of laryngeal extubation and the time to analepsia were recorded. Plasma concentration of glucose, epinephrine （E）, β endorphin（β-EP） were measured at following time points： 5 min after coming into operation room（T0）, one minute（T1 ） and three minute （T2） after artificial pneumoperitoneum, seperating pathological tissue with normal tissue （T3）, and the end of operation （T4）. Results The concentration of glucose,β-EP and E were significantly increased in four groups at T1-T4 when compared to those at T0 （P〈0. 05）. Compared to group B, the concentration of glucose, β-EP and E at T1 , T2, and T4 in group A, BA, and C were decreased significantly（P〈0.05）. The consumption of propofol was significantly lower in the group B than other groups（P〈0.05）, while the time of analepsia in group B was earlier than other groups（P〈0.05）. The consumption of phenylephrine in group BA was more than groups B and A（P〈0.05）. The consumption of nicardipine and esmolol in group B was more than groups BA and A（P〈0.05）. Conclusion Joint monitoring of BIS and AAI is more accurate for controlling the depth of anesthesia, hemodynamics and stress responses.

关 键 词：脑电双频指数 听觉诱发电位 妇科腔镜手术 应激 

分 类 号：R614[医药卫生—麻醉学]