脑电双频指数和听觉诱发电位指数指导老年患者硬脊膜外腔阻滞复合吸入全身麻醉的麻醉镇静深度调控  

Bispectral index and auditory evoked potentials index monitoring during maintenance of anesthesia in elderly patients under inhalation anesthesia combined with epidural block

作　　者：孙卓真[1] 葛圣金[2] 李敏[2] 薛张纲[2] 

机构地区：[1]复旦大学附属中山医院妇产科,上海200032 [2]复旦大学附属中山医院麻醉科,上海200032

出　　处：《上海医学》2013年第10期851-854,共4页Shanghai Medical Journal

摘　　要：目的探讨脑电双频指数（BIS）和中潜伏期听觉诱发电位指数（AAI）指导老年患者硬脊膜外腔阻滞复合七氟烷吸入全身麻醉的麻醉维持期镇静深度调控的有效性。方法选择美国麻醉医师学会（ASA）分级I或Ⅱ级，择期在硬脊膜外腔阻滞复合全身麻醉下行腹部手术的65～75岁患者45例，随机分人3组，每组15例。分别根据AAI值（AAI组）、BIS值（BIS组）或临床医师经验（对照组）来调节吸入全身麻醉维持期的七氟烷吸人体积分数。AAI组患者的AAI值维持于15±5（10～20），BIS组的BIS值维持于50土10（40～60）。观察3组患者在麻醉维持期单位时间的七氟烷消耗量、苏醒时间，术中高血压、低血压的发生率，以及有无术中知晓（显性记忆）发生。结果3组间麻醉维持期的AAI值、BIS值、每30min的七氟烷消耗量和苏醒时间的差异均无统计学意义（P值均〉0．05）。AAI组、BIS组、对照组的低血压发生率分别为4／15、2／15、3／15，3组间的差异无统计学意义（P〉O．05）。3组患者均未发生术中高血压、术后显性记忆。结论应用AAI值或BIS值监测老年患者硬脊膜外腔阻滞复合七氟烷吸入麻醉的麻醉深度有效，但不能减少单位时间的七氟烷用量，不能缩短苏醒时间。Objective To assess the performance of bispectral index （BIS） and rapidly extracted auditory evoked potentials index （AAI） in monitoring sedation in elderly patients under inhalation anesthesia of sevoflurane combined with epidural block during maintenance of anesthesia. Methods Forty-five patients, American Society of Anesthesiologists （ASA） Ⅰ -Ⅱ , aged 65-75 years, schedule for abdominal surgery under inhalation anesthesia of sevoflurane combined with epidural block, were randomized into three groups. In AAI group, AAI was regulated between 10 and 20. In BIS group, BIS was regulated between 40 and 60. In control group, the sevoflurane concentration of vaporizer was changed under the direction of anesthesiologist. The consumption of sevoflurane during maintenance of anesthesia and recovery time from anesthesia were recorded. The occurrence of hypertension, hypotension and awareness during anesthesia were compared among three groups. Results There were no significant differences in the consumption of sevoflurane per 30 minutes or recovery time from anesthesia among three groups （all P〈0.05）. The incidence of hypotension was 4/15,2/15 and 3/15 in AAI group, BIS group and control group, respectively （P〉0.05）. No perioperative hypertension or postoperative explicit memory occurred in all patients. Conclusion Both BIS and AAI can effectively monitor depth of anesthesia in elderly patient under inhalation anesthesia of sevoflurance combined with epidural block. However, they can not reduce the consumption of sevoflurane and recovery time from anesthesia.

关 键 词：脑电双频指数 听觉诱发电位指数 麻醉深度 老年 硬脊膜外腔阻滞 

分 类 号：R614[医药卫生—麻醉学]