体外循环前后麻醉深度的变化

Changes of anesthestic depth in patients around cardiopulmonary hypass

目的观察心内直视手术体外循环前后麻醉深度的变化。方法择期二尖瓣置换病人40例,ASAⅡ￣Ⅲ级。咪唑安定、芬太尼、维库溴胺、福尔利诱导气管插管,芬太尼、维库溴胺维持麻醉,体外循环中停用麻醉药。体外循环采用中度低温和中度血液稀释,手术时间(216.8±36.5)min,体外循环时间(68.6±12.8)min,主动脉阻断(45.5±10.5)min,最低温度(24.2±2.5)℃。用丹麦A-line麻醉深度监测仪监测体外循环前后听觉诱发电位指数(AAI)的变化。结果转流开始后AAI较转前降低,且转流中一直处于较低水平,和转流前相比差异有显著性(P<0.05),停机后1h左右上升至转前水平。结论体外循环中麻醉深度较转流前加深,血压升高时不宜应用麻醉药,宜用扩血管药物调整。

To study the changes of anesthestic depth in patients undering open cardiac surgery aroud cardiopulmonary bypass (CPB). Intravenous combined anesthesia was used in 40 patients (18 mail, 22 femail ) undergoing open cardiac surgery. Age (52.6±12.5) years and body weight (56.8±16.5) kg. Anesthesia was maintained with intravenous fentanyl and vecuronium and etomidate fat emulsion. Anesthesia was maintained with intravenous fentanyl and vecuronium. The general anesthestic were not used during CBP. The controlled hypothermia under CPB was used during surgery. The mean times of surgery, CPB, and the clamp of aorta were (216.8±36.5) min, (68.6±12.8) min, (45.5±10.5) min respectively. The lowest body temperature was (24.2±2.5) ℃. The auditory evoked potential index (AAI) around CPB was monitored by A-line anesthesitc depth monitor. AAI decreased significantly during CPB as compared with the level before CPB. After rewarming and restoring heart beats, the AAI still decreased significantly and was kept to the end of CPB. [Conclusion] The anesthestic depth in patients during CPB is deeper than that before CPB. Drugs of expanding blood vessel should be used for patients when blood pressure is high during CPB.