3种声强下脑干听觉诱发电位在颅脑手术麻醉深度评估中的应用

The Applied Evaluation of Depth of Anaesthesia with Brainstem Auditory Evoked Potential in Three Different Decibels Level in Patients Undergoing Craniocerebral Surgery

目的研究应用3种声强下脑干听觉诱发电位(Brainstem auditory evoked potential,BAEP)监测颅脑手术麻醉深度的可行性。方法选择听力正常的经头部CT或MRI证实有颅内占位病变须行开颅手术的择期手术患者(ASAⅠ-Ⅱ级)16例,采用丹麦维迪公司四通道Keytoint肌电诱发电位仪监测并记录麻醉不同时间点的Ⅰ、Ⅲ、Ⅴ波潜伏期(potential time,PL),观察PL在不同麻醉时间点麻醉深度的变化,探讨神经外科手术患者术中不同麻醉深度和BAEP变化之间的规律及其临床意义。结果3种声强下Ⅰ、Ⅲ、Ⅴ波的PL都比麻醉前延长,各波波峰逐渐右移,尤以Ⅴ波延长最为明显,并持续至停药时,拔管时各波PL明显缩短,Ⅰ波PL最先缩短,但仍未恢复麻醉前状态。结论BAEP可用于颅脑手术的麻醉深度监测,3种声强下的阳性检出率均高。Ⅰ、Ⅲ、Ⅴ波的PL与麻醉深度关系密切,可作为判断麻醉变浅的敏感指标。

Objective To study applying depth of anaesthesia with Brainstem Auditory Evoked Potential in three different decibels level in patients undergoing craniocerebral surgery. Methods 16 patients（ASA Ⅰ to Ⅱ ） confirmed by CT or MRI were recruited for craniocerebral surgery with occupation in the cranial cavity. We applied 4 passageway Keytoint systems which were made by DANTEC Company in Denmark. Then we marked every wave and measured peak latency（PL）of Ⅰ、Ⅲ、Ⅴ wave and the changes of BAEP at different time during general anesthesia. According to these changes we explored the depth of anesthesia during anesthesia for craniocerebral surgery, the changing rules of BAEP and it＇ s clinical significance. Results The PL of Ⅰ、Ⅲ、Ⅴ waves were more lengthened than before anesthesia at uncinsciousness. Each peak wave moved to right gradually, especially V wave. Up to intubation, every wave lengthened intubation until end-input. Every wave of PL shortened obviously at extubation. PL of Ⅰ wave shortened at first, but not as recovered as baseline value. Conclusions BAEP could be used to detect the depth of anaesthesia, and the rate of detectability was high in three different decibels level. PL of Ⅰ、Ⅲ、Ⅴ waves had close relation with depth of anaesthesia. They were sensitive variables to reflect the change of depth of anaesthesia.