脑电双频谱指数监测老年人地氟醚全麻深度的临床研究

Clinical study on bispectral index in mornitoring the depth of desflurane anesthesia in the elderly

目的:研究无手术刺激条件下地氟醚对老年人脑电双频谱指数(BIS)的影响,评估BIS在地氟醚吸入 麻醉深度监测中的应用价值。方法:40例ASAⅠ～Ⅲ级,拟择期在气管内全麻下手术患者,按年龄分为2组:老年 组(年龄≥65岁,n=20例),中青年组(年龄18～55岁,n=20例)。环甲膜穿刺行气管内表面麻醉后予异丙 酚2mg/kg、维库溴铵0.1mg/kg静脉注射诱导,插管后吸入地氟醚维持麻醉,逐步调整吸入浓度,使地氟 醚呼气末浓度依次维持在0.6MAC,1.0MAC,1.3MAC,每一浓度均稳定20min。观察指标包括MAP,HR和BIS 记录时点分别为麻醉前、注射异丙酚后2min、气管插管时、气管插管后2min、地氟醚呼气末浓度为0.6MAC,1. MAC,1.3MAC时。结果:在地氟醚麻醉期,当地氟醚呼气末浓度由0.6～1.3MAC递增时,2组患者MAP,HR无 显著变化(P>0.05),MAP,HR的变化与地氟醚无量效关系。在地氟醚麻醉期,2组患者BIS在整个麻醉过程中的 变化不同(P<0.05)。随着地氟醚呼气末浓度增加,BIS逐渐下降,但每组患者各浓度间BIS的变化差异无统计学 意义(P>0.05)。BIS与地氟醚呼气末浓度呈高度相关,BIS与地氟醚在老年组、中青年组的相关系数分别为 -0.996,-0.946(P<0.05)。结论:脑电双频谱指数与地氟醚呼气末浓度呈高度剂量相关性。

Objective To evaluate the values of bispectral index (BIS) in mornitoring the depth of desflurane anesthesia in the elderly by observing the changes of BIS at various end-tidal desflurane concentrations. Methods BIS was used to monitor the depth of desflurane anesthesia in the elderly without surgery stimulation. Forty ASA physical status Ⅰ~Ⅲ patients undergoing general anesthesia were divided into 2 groups with 20 in each group:Group Elderly (≥65 years) and Group Youth (18～55 years).Anesthesia was induced with propofol 2.0mg/kg and vecuronium 0.1mg/kg including the endotracheal topical anesthesia with 2% lidocaine. After the desflurane in oxygen, each concentration of desflurane was maintained for 20 minutes. The changes of mean arterial blood pressure (MAP), heart rate (HR) and BIS were recorded simultaneously. The timepoints setting for observation were: preanesthesia, 2 minutes after the anesthesia, endotracheal intubation, 2 minutes after the intubation, and end-tidal concentration of desflurane at 0.6 MAC, 1.0 MAC and 1.3 MAC. Results During anesthesia of desflurane, MAP and HR did not change significantly in the 2 groups with increasing end-tidal desflurane concentration from 0.6MAC to 1.3 MAC (P>0.05). BIS decreased significantly than that at preanesthesia in the 2 groups during anesthesia of desflurane (P<0.05). The changes of BIS were different in the 2 groups during the whole anesthesia (P<0.05). As the concentration of desflurane increased, BIS decreased gradually but there were no significant changes on BIS in the 2 groups (P>0.05). In general, BIS highly correlated with the end-tidal desflurane concentration. The coefficient of product-moment correlation (r) between BIS and the end-tidal desflurane concentration was -0.996 and -0.946 in Group Elderly and Youth (P<0.05). Conclusion BIS highly correlates with the end-tidal desflurane concentration which is used to evaluate the depth of desflurane anesthesia in the elderly and youth. There is different depth of anesthesia by BIS in the elderly or youth at the same end-tidal desflurane concentration.