听觉诱发电位指数、脑电双频指数及心血管反应评估“过浅麻醉”的价值

Significance of A-line ARX index, bispectral index and hemodynamic responses in evaluating “inadequate anesthesia” during propofol induction

目的 通过研究丙泊酚诱导过程中，听觉诱发电位指数（AAI）、脑电双频指数（BIS）及心血管反应与插管体动的关系，探讨上述监测手段是否能够反映“过浅麻醉”。方法 35例ASAⅠ～Ⅱ级妇科择期手术患者，以丙泊酚进行诱导，患者入睡后，用压力袖带隔离一侧前臂，静注维库溴铵0．1mg／kg。当丙泊酚靶控输注（TCI）达到设定血浆靶浓度（3．5μg／ml）后行气管内插管。记录隔离侧手臂运动（体动）情况，并以是否发生体动反应为准将患者分为体动组与非体动组。记录患者诱导前、插管前的SBP、DBP、HR、BIS、AAI及插管后2min内上述指标的最大值。结果 体动组AAI插管后明显高于插管前（P〈0．01），而非体动组插管前、后的差异无显著意义；两组患者BIS插管前、后组内及组间的差异均无显著意义；插管引起的DBP、SBP增高体动组明显大于非体动组（P〈0．01），但HR变化两组相似。结论 BIS仅是衡量睡眠深度的指标，AAI及BP反映“过浅麻醉”，反映机体对伤害性刺激的反应较BIS敏感。

Objective To evaluate the significance of A-line ARX index（AAI）,bispectral index （BIS）, and hemodynamic responses during propofol induction in detecting ＂inadequate anesthesia＂. Methods Thirty-five ASA Ⅰ - Ⅱ female patients were induced with propofol. After loss of consciousness,and before administration of vecuronium 0. 1 mg/kg, a tourniquet was applied on one arm and inflated to 150 mmHg above systolic pressure. When TCI reached the blood concentration set （3.5 μg/ml）, the trachea was intubated and all patients were assigned to either move group or non-move group according to presence or absence of gross movement within the 1st minute after tracheal intubation. The values of BIS,AAI and hemodynamic parameters of blood pressure and heart rate pre-induction, before laryngoscopy were recorded,and the maximal values of the above indices within 2 min after intubation were also measured. Results AAI in move group only increased significantly after tracheal intubation（P〈0. 01,vs. pre-larngoscopy）. Neither within nor intergroup difference was found in BIS before or after intubation.Tracheal intubation caused greater blood pressure increase in move group than that in non-move group（P〈0. 01）, but heart rate of both groups were similar after intubation. Conclusion BIS is just an index that reflects sleep level, but AAI and blood pressure are the useful monitorings to detect ＂inadequate anesthesia＂ during propofol anesthesia.