脑电双频指数指导老年病人异丙酚麻醉诱导用量

THE GUIDANCE OF BISPECTRAL INDEX ON ADMINISTERED DOSE OF PROPOFOL OF ELDERLY PATIENTS DURING ANESTHETIC INDUCTION

[目的]通过监测老年病人麻醉诱导时脑电双频指数(BIS)的变化,探讨既能维持足够麻醉深度又能避免严重低血压的异丙酚诱导用量。[方法]40例ASA II～I级的老年病人(65～85岁),随机分成两组。A组静脉注射异丙酚1.6 mg/kg;B组静脉注射异丙酚,其用量是使BIS下降到40～50时的用量。两组均复合维库溴铵0.1 mg/kg和瑞芬太尼1ug/kg诱导后行气管插管分别记录基础值、插管前、插管后1 min、5 min和10 min时的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR),同时记录诱导异丙酚用药量和BIS的变化。[结果]A组异丙酚诱导用药量(99.7±18.05)mg,平均(1.64±0.7)mg/kg,B组(82.9±12.5)mg,平均(1.35±0.5)mg/kg,差异有统计学意义(P﹤0.05)。A组血压(BP)和BIS比B组明显降低。[结论]老年病人异丙酚麻醉诱导的合适用量为(1.35±0.5)mg/kg;既能维持老年人足够的麻醉深度又能避免严重低血压的发生。

[Objective] To study the administered dose of propofol to maintain adequate anesthesia and prevent hypotension by monitoring bispectral index （BIS） of elderly patients during anesthetic induction. [ Methods] Forty patients aged from 65 to 85, ASA physical status Ⅰ-Ⅱ , were randomly divided into two groups. All patients received general anesthesia and tracheal intubation. Anesthesia was induced with propofol, vecuronium 0.1mg/kg, and remifentanil 1ug/kg. And group A was given intravenous injection of porpofol at the dose of 1.6 mg/kg, while group B was given intravenous injection of porpofol at the dose that could make BIS decrease to 40-50. Otherwise, the systolic blood pressure （SBP）, diastolic blood pressure （DBP）, mean artery pressure （MAP） and heart pressure （HR） were recorded before anesthetic incubation and in the minutes of 1, 5 and 10 atter anesthetic induction. The dose of propofol and the changes of BIS in two groups were also recorded. [Results] The administered dose of propofol during anesthetic induction in Group A was （99.7± 18.05）mg, and the average was （1.64± 0.7） mg/kg, while that in group B was （82.9±12.5）mg, and the average was （1.35 ± 0.5）mg/kg. There was significant difference between the two groups （P〈 0.05）. The blood pressure （BP） and BIS in group A decrease more obviously than those in group B. [Conclusions] The reasonable dose of propofol for elderly patients is （1.35±0.5）mg/kg; it can maintain adequate depth of anesthesia and prevent hypotension during anesthetic induction for the aged people.