两种全麻方式下二氧化碳气腹对老年妇科手术患者脑电双频指数和氧代谢的影响  

Effects of carbon dioxide pneumoperitoneum on bispectral index and oxygen metabolism in elderly patients undergoing laparoscopic hysterectomy under two different anesthesia methods

作　　者：高丽君[1] 沈虹春[1] 戎小平[1] 

机构地区：[1]慈溪市妇幼保健院麻醉科,315300

出　　处：《浙江医学》2015年第11期945-947,950,共4页Zhejiang Medical Journal

摘　　要：目的 观察丙泊酚与七氟烷麻醉时二氧化碳气腹对老年妇科手术患者脑电双频指数（BIS）及氧代谢的影响.方法 选取老年妇科腹腔镜子宫切除手术患者60例,按随机数字表法分为丙泊酚组、七氟烷组,各30例,气腹时间均＞90 min.根据BIS调节麻醉深度,丙泊酚组调节丙泊酚用量在60 ～ 200μ g/（kg· min）、七氟烷组调节吸入量在0.8～ 1.3 MAC.记录气腹前及气腹后10、30、60及90min各时间点平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）、呼气末二氧化碳分压（PETCO2）、BIS、脑动脉血氧含量（CaO2）、颈内静脉血氧含量（CjvO2）、动脉-颈内静脉血氧含量差（Da-jvO2）、脑氧摄取率（CERO2）、血乳酸（Lac）等指标.结果 两组患者根据BIS调节麻醉深度,BIS在气腹前后均保持稳定.两组患者MAP、HR、PETCO2、CaO2、CjvO2、Da-jvO2、CERO2、Lac气腹后各时间点较气腹前有明显变化,其中PaCO2增高（P＜0.05）,CaO2、Da-jvO2、CERO2下降（P＜0.05）,CjvO2、Lac增高（P＜0.05）.两组患者比较,在气腹后60min丙泊酚组MAP、HR较七氟烷组低（P＜0.05）,丙泊酚组CjvO2较七氟烷组高（P＜0.05）,丙泊酚组Da-jvO2、CERO2较七氟烷组低（P＜0.05）.结论 老年妇科手术患者二氧化碳气腹可以影响BIS及氧代谢,丙泊酚比七氟烷对两者的影响更明显.Objective To investigate the effects of carbon dioxide （CO2） pneumoperitoneum on bispectral index （BIS） and oxygen metabolism in elderly patients undergoing laparoscopic hysterectomy under different anesthesia methods. Methods Sixty elderly patients undergoing laparoscopic hysterectomy operation were randomly divided into propofol group （P） and sevofiurane group （S） with 30 cases in each group, According to the depth of anesthesia adjusted by the BIS, the dosage of propofol of group P was in 60-200 p g/ （kg .min）, and the volume of inhaled sevoflurane in group S was 0.8 - 1.3 MAC. MAP, HR, SpO2, PBCO2, BIS, CaO2, CjvO2, Da-jvO2, CERO2, and Lac were recorded before CO~ pneumoperitoneum and 10min, 30min, 60min, 90min after pneumoperitoneum. Results The depth of anesthesia in all patients was adjusted by BIS, and the BIS value was remained robust in the pre- and post- pneumoperitoneum. The MAP, HR, PETCO2, CaO2, CjvO2, Da-jvO2, CERO2 and Lac of pre-pneumoperitoneum in two groups were changed significantly by compared with the post-pneumoperitoneum at multiple time points, and PErCO2, CjvO2 and Lac were significantly increased （P〈0.05）, the CaO2, Da-jvO2, CERO2 were significantly decreased （P〈0.05）. At 60 min after pneumoperitoneum, the MAP, HR, Da-jvO2, CERO2 in group P were lower than those in group S（P〈 0.05）, while the CjvO2 in group P was higher than that in group S（P〈0.05）. Conclusion CO2 pneumoperitoneum may affect the BIS and oxygen metabolism in elderly gynecologic patients, it is more significant when patients have anesthesia with propofol.

关 键 词：全身麻醉 气腹 老年人 妇科 脑电双频指数 氧代谢 

分 类 号：R614[医药卫生—麻醉学]