摘要
目的:观察并分析围术期应用脑电双频谱指数(BIS)及听觉诱发电位指数(AAI)监测对七氟烷用量及对术毕苏醒时间和拔管时间的影响,并与传统以血流动力学指标来判断麻醉深度组相比较。方法:择期七氟烷全麻下行腹腔镜胆囊切除手术患者45例,ASAⅠ~Ⅱ级.随机分为三组:控制组(根据患者的血压来调节ETsevo。保持血压和心率波动在基础值的±15%)、AAI组(保持术中AAI值维持在15~20)、BIS组(保持术中BIS值维持在45~55),每组15例。氧流量2L/min。于麻醉诱导前(基础值).T1.T2、T3,T4、T5和苏醒即刻(T6)记录MAP.HR.SPO2、AAI、BIS和ETsevo,并记录苏醒时间和拔管时间。术毕1小时内取3个时点行OAA/S评分。结果:与AAI组和BIS组相比较,控制组麻醉维持期ETsevo大于其它两组(P〈0.05)。AAI组与BIS组的苏醒时间和拔管时间均较控制组短(p〈0.05)。但是术后1小时内各时点的OAA/S评分三组之间无明显差异。同时.AAI和BIS两组之间无差异。结论:将脑电监测运用于吸入麻醉能在很大程度上减少七氟烷用量,缩短患者麻醉苏醒时间和拔管时间.更有预见性的使用吸入麻醉。
Objective: To evaluate the impact of intraoperative monitoring with the electroencephalogram bispectral index or auditory evoked potential device on the usage of sevofiurane and the time to eye-opening and extubation from the end of operation, OAA/S scale scores were recorded. Methods: Forty-five ASA Ⅰ and Ⅱ adult patients were randomly assigned to one of three monitoring groups: standard clinical practice(control), BIS-guided, or AAI-guided. After a induction of midazolam 0.05 mg·kg^-1 , propofol 1.5mg·kg^-1 and fentanyl 3ug·kg^-1,laryngoscopy and intubation were facilitated with intravenous vecuronium 0.1 mg·kg^-1,and anesthesia was maintained with sevofiurane. In the control group, the anesthesiologists were not permitted to observe the BIS or AAI index values during the intraoperative period. In the AAI guided group, the volatile anesthetic was titrated to maintain a AAI value in the range of 15-20. In the BIS-guided group, the targeted BIS index range was 45-55. MAP, HR, SpO2, the BIS indices and AAI indices, as well as end-tidal sevoflurane concentration, were recorded at 3-5 min intervals. Observer's assessment of alertness,sedation(OAA/S) scale score was assessed after surgery. Result : The AAI- and BIS-guided groups were administered significantly smaller average end-tidal sevoflurane concentrations than the control group (P〈0.05).The emergence times to eye opening, tracheal extubation were consistently shorter in the AEP and BIS groups (p〈0.05). OAA/S scale scores were not significantly different in three groups. However, there were no significant outcome differences between the two cerebral monitored groups. Conclusion: We concluded that cerebral monitoring with either the BIS or AAI devices reduced the maintenance anesthetic (sevoflurane) requirement, resulting in a shorter length of eye opening, tracheal extubation after surgery.
出处
《麻醉与监护论坛》
2009年第4期157-159,共3页
Forum of Anesthesia and Monitoring