丙泊酚与异氟醚麻醉时听觉诱发电位指数的变化

Effects of propofol and isoflurane on auditory evoked potential index during surgery

目的比较静脉麻醉药丙泊酚与吸入麻醉药异氟醚麻醉时听觉诱发电位指数 (AEPI)的变化规律。方法 30例拟行全身麻醉下择期手术患者 ,无听力障碍和严重神经学疾患 ,非颅脑手术 ,静注咪唑安定 0 .0 8mg/kg后 ,随机分为两组 ,每组 15例 ,其中组I静注丙泊酚靶控浓度 2 μg/mL ;组II吸入异氟醚使呼气末浓度 (ET % )达 1.5 %。随后静注芬太尼 (5 μg/kg) ,维库溴铵 0 .15mg/kg。观察整个诱导期及麻醉手术中AEPI的变化规律。结果两组病人用药后AEPI进行性降低至 30以下 ,所用时间分别为(6 .2± 2 .5 )、(15 .2± 1.9)min ,组II病人AEPI随吸入浓度增加而进行性降低。插管后AEPI有上升趋势 ,但仍能维持AEPI于 30以下 ;组I病人麻醉期间AEPI不稳定 (短暂升高达 4 0以上 )的发生率 (4 0 % )较组II病人 (13% )高 (P <0 .0 1) ;术后访视所有病人无术中知晓。结论丙泊酚、异氟醚均可降低AEPI,丙泊酚麻醉期AEPI有较高的波动率 。

Objective To assess the effect of intravenous anesthetics propofol and inhaled anesthetics isoflurane on auditory evoked potential index (AEPI) and the value of AEPI in the monitoring of anesthetic depth. Methods Thirty patients scheduled for elective surgery with no audition obstacle and non-neurotic were randomly divided into 2 groups and received propofol TCI 2 μg/mL (group I, n=15), or inhaled isoflurane P ET1.5% (group II, n=15), respectively. The induction of anesthesia with midazolam 0.08 mg/kg, propofol or isoflurane, fentanyl 5 μg/kg, vecuronium 0.15 mg/kg and then tracheal intubation were performed. The auditory evoked potential indexes (AEPI) were recorded during anesthesia period. Results The AEPI was decreased to less than 30 in group I and II. The time from induction to AEPI under 30 was (6.2±2.5)min(group I),(15.2±1.9)min (group II) respectively. During anesthesia, the incidence of AEPI instability were much more profound in group I (40%) than in group II (13%) (P<0.01). Conclusion The propofol and isoflurane decrease the APEI to less than 30. The changes of AEPI were not accorded between the propofol and isoflurane during surgery. The AEPI monitoring is valuable in assessment of anesthetic depth during anesthesia with propofol or isoflurane.