硬膜外麻醉下经不同途径使用芬太尼的脑电双频指数值和血流动力学变化  

Effects of fentanyl administered by different routes on bispectral index and hemodynamic changes under epidural anesthesia

作　　者：李军科[1] 杨小平[1] 薛张纲[2] 

机构地区：[1]台州学院医学院附属台州市立医院麻醉科,浙江台州318000 [2]复旦大学附属中山医院麻醉科,上海200032

出　　处：《中国现代医生》2015年第24期125-128,共4页China Modern Doctor

基　　金：浙江省医学会临床科研基金项目(2011ZYC-A112)

摘　　要：目的观察硬膜外麻醉下经硬膜外腔与静脉途径使用芬太尼的脑电双频指数值与血流动力学变化，探讨脑电双频指数能否反映芬太尼的镇静水平以及适合于辅助用药的芬太尼途径。方法63例择期行子宫全切术的患者随机分为NO组、Ⅳ组、EP组各21例，经硬膜外（T12L1）注入2％利多卡因3mL，5min后给予1％利多卡因＋0．25％地卡因混合液15mL，15min后NO组经硬膜外腔注射0．9％氯化钠溶液3mL。Ⅳ组采用经静脉注射含芬太尼20μg的0．9％氯化钠溶液3mL，EP组采用经硬膜外腔注射含芬太尼20μg的0．9％氯化钠溶液3mL，记录给药前（T0）、给药结束后15min（T1）、30min（T2）、45min（T3）、60min（T4）、术毕（T5）共6个点三组的BIS值和血流动力学变化。结果与T0相比，T1～T5时Ⅳ组和EP组的BIS值明显降低（P〈0．01）；EP组在T1～T5时BIS值明显低于NO组和Ⅳ组（P〈0．01），Ⅳ组在T1～T5时BIS值明显低于NO组（P〈0．01）。结论脑电双频指数能反映芬太尼的镇静水平．芬太尼经硬膜外腔注射比经静脉注射起到更好的镇静水平，而且血流动力学无明显改变。Objective To evaluate the effects of fentanyl administered by epidural and intravenous on bispectral index （BIS） and hemodynamie changes under epidural anesthesia. In this study, whether BIS value can reflect the sedation level of fentanyl, and the appropriate route of fentanyl administration as an adjuvant for epidural anesthesia are also discussed. Methods Sixty-three patients scheduled for elective abdominal hysterectomy were randomized to one of three groups （n=21 in each group）. Fifteen minutes after epidural anesthesia, patients of NO group received epidural ad- ministration of 3 mL normal saline, patients of group Ⅳ received intravenous administration of 20 μg fentanyl（dissolved in 3 mL normal saline） and patients of EP group received epidural administration of 20 μg fentanyl（dissolved in 3 mL normal saline）. BIS values and hemodynamic changes from individual patients were measured at six points in time： 0 minutes （T0）, 15 minutes（T1）, 30 minutes（T2）, 45 minutes（T3）, 60 minutes（T4） after normal saline or fentanyl adminis- tration, and at the end of surgery（T5）. Results Compared with To, in group Ⅳ and group EP, there were significant dif- ferences in the values of BIS at T1-5（P〈0.01）. The BIS values at T1-5 were significantly lower in EP group than in NO group and Ⅳ group（P〈0.01）. The BIS values at T1-5 were significantly lower in Ⅳ group than in NO group （P〈0.01）. Conclusion BIS value can reflect the sedation level of fentanyl. Epidural administration of fentanyl offer a better level of sedation and fewer hemodynamie changes than intravenous administration of fentanyl.

关 键 词：芬太尼 脑电描记术 硬膜外腔 静脉 

分 类 号：R614.4[医药卫生—麻醉学]