异氟醚全麻深度的多指标判断

Multi-index Monitoring in Assessing Depth of Isoflurane Anesthesia

由于箭毒和新的麻醉技术的应用，乙醚麻醉分期已不再适用，急需寻找新的方法判断麻醉深度。本研究通过观察６０例在模拟刺激和手术刺激下异氟醚０．４～１．６ＭＡＣ呼气未浓度（ＥＴｉｓｏ）与脑电频率和波幅（ＥＥＧｆ、ＥＥＧａｍｐ）、额肌电波幅（ＥＭＧｆ）、手指动脉收缩和舒张压（ＦＡＰｓ，ＦＡＰｄ）、肱动脉收缩和舒张压（ＢＰｓ，ＢＰｄ）、指端容积波波幅（Ｐｌｅｔｈ）、心率（ＨＲ）、诱发性食管下段收缩性（ＰＬＥＣ）、吸呼未氧浓度差（Ｉ－ＥＯ２）、呼末二氧化碳浓度（ＥＴＣＯ２）１２项指标的相关性分析，对上述各指标在全麻深度判断中的作用作一初步评价。结果显示：①６０例各指标值与ＥＴｉｓｏ的个体相关性均极显著敏感，其中ＦＡＰｓ对９０％的病例敏感，其它指标的敏感性依次为ＦＡＰｄ、ＢＰｄ、Ｐｌｅｔｈ、ＢＰｓ、Ｉ－ＥＯ２、ＥＥＧｆ、ＨＲ、ＰＬＥＣ、ＥＭＧｆ、ＥＥＧａｍｐ、ＥＴＣＯ２。②从敏感指标的个数与相应的病例数的关系中看出，虽然大部分病例（３８例，６３．３％）对７～９项指标敏感，但每例对１２项指标的敏感程度各异，且无一项指标对所有病例均敏感，故有必要在诱导后的早期用多指标监测，才有可能找出对每一个体敏感的指标，用于其后的麻醉深度判?

ince the introduction of curare and new techniques,Guedel’s classic clinic signs of ether anesthesia have nopart to play in assessing the adequacy or depth of modern anesthesia. It is surprising that there was littleobviouseffort directed towards establishing some means for assessing the adequacy of anesthesia in a paralyzed patient.Thus the correlations between the end-tidal isoflurane concentratinos (ETiso) and the values of 12 monitoring in-dices(EEGf,EEGamp,EMGf,FAPs,FAPd,BPs,BPd,Pleth,HR,PLEC,I-EO2,ETCO2)were studied in 60patients undergoing elective surgical operations.The results show that the correlations between the ETiso and the values of each index were very significant.Among the indices studied FAPs was sensitive to 90%of the patients observed,the overall sensitivities of other in-dices were attenuated in the order of FAPd,BPd,Pleth,BPs,1-EO2,EEGf,EEGamp and ETCO2.But the orderof sensitivity of 12 indices for each of the 60 patients was different from one to another and no single index was al-ways preferable to the others, In order to screen out the sensitive indices for each specific individual,multiple in-dices are thus recommended for assessing anesthetic depth in the early period following induction.