BIS和AEPex比较性研究术前静注可乐定对麻醉深度的影响

The effects of preanesthetic intravenous clonidine on depth of anesthesia detected by BIS and AEPex

目的 比较术前静注不同剂量的可乐定对麻醉深度和麻醉药用量的影响。方法 选 择ASAⅠ～Ⅱ级拟行腹腔镜胆囊切除术的患者48例,采用随机对照单盲的方法分四组,分别在术前 30min静脉缓慢注入可乐定0μg/kg(Ⅰ组,为对照组,生理盐水2～3ml)、2μg/kg(Ⅱ组)、3μg/kg (Ⅲ组)、4μg/kg(Ⅳ组)。使用丙泊酚、芬太尼、维库溴铵联合静脉麻醉,芬太尼首剂3μg/kg,2μg· kg-1·h-1维持,调节丙泊酚的输注速度(6～12mg·kg-1·h-1)以达到满意的麻醉深度,维持BP (收缩压或舒张压)在术前值±20%范围内波动。观测脑电双频指数(BIS)和听觉诱发电位指数 (AEPex)的变化,比较各组使用丙泊酚剂量的差异。结果 Ⅲ、Ⅳ组与Ⅰ组相比,BIS和AEPex值在 诱导后、插管后、气腹前、气腹后均低于Ⅰ组,差异有显著性(P<0.05)。Ⅱ组与Ⅰ组相比差异无显著 性。Ⅰ、Ⅱ、Ⅲ、Ⅳ组使用丙泊酚的剂量分别为8.0、7.8、6.8和6.7mg·kg-1·h-1。Ⅲ、Ⅳ组的丙泊 酚使用量低于Ⅰ组,差异有显著性(P<0.05)。结论 术前静脉使用大于2μg/kg的可乐定可以减 少麻醉药的用量,但以BP、HR稳定性来判断麻醉深度的方法,反而使麻醉的深度过深,BP、HR的波 动也大,应该适当减少麻醉药的用量。

Objective To investigate the effects of preanesthetic intravenous clonidine on depth of anesthesia. Methods Patients ASA physical statusⅠandⅡ,scheduled for laparoscopic cholecystectomy. Were randomized to one of four treatment groups(placebo, clonidine 2 μg/kg, clonidine 3 μg/kg, clonidine 4 μg/kg intravenously administered 30 min before induction of anesthefsia,n=12). Anesthesia was induced with fentanyl 3 μg/kg, and vecuronium 0.1 mg/kg, and propofol 2 mg/kg. After tracheal intubation,fentanyl 2 μg·kg -1·h -1 was infused immediately until the end of anesthesia. Additional vecuronium was used for muscle relaxation. Heart rate, blood pressure bispectral index(BIS),auditory potential evoked index (AEPex) and dose of drug used were recorded. Results Compared with the control group, clonidine 3 μg/kg and 4 μg/kg significantly attenuated BIS, AEPex before and after anesthesia induction, after intubation, before and after artificial pneumoperitoneum(P<0.05). The total requirements (the mean infusion rates) of propofol in placebo, clonidine 2 μg/kg, clonidine 3 μg/kg, clonidine 4 μg/kg groups were 8.0, 7.8, 6.8 and 6.7 mg·kg -1·h -1 respectively. The less propofol was required in 3 μg/kg and 4 μg/kg groups significantly(P<0.05). Conclusion During anesthesia according to hemodynamic variables, preanesthetic intravenous clonidine 3 and 4 μg/kg can deepen the depth of anesthesia and decrease MAP and HR without prolongation of recovery. So in clinical indicating that in case of anesthesia with clonidine, the requirement of anethetics should be reduced.