全麻诱导插管期间听觉诱发电位和脑电双频指数变化的临床研究

Clinical study on relationship between bispectral and auditory evoked pontential change during anesthesia induction intubation

目的探讨用异丙酚和维库溴铵全麻诱导插管期间脑电双频指数(Bispectral index,BIS)和听觉诱发电位指数(auditory evoked pontential index,AEPindex)的变化及其临床意义。方法ASAⅠ、Ⅱ级,择期在全麻下行腹部手术的患者(18～55岁)40例。2%利多卡因2mL环甲膜穿刺气管内表麻,异丙酚2mg/kg和维库溴铵0.1mg/kg静脉诱导,3～5min后气管插管,控制呼吸(IPPV,潮气量6～8mL/kg,PETCO235～40mmHg)。分别于麻醉前(T0),诱导后2min(T1),插管后2min(T2),插管后5min(T4),记录MAP、HR、SEF、BIS和AEP。结果诱导后各观察指标均较诱导前的基础值有所下降,插管后明显上升,血流动力学和BIS、AEPindex的变化趋势一致。结论BIS、AEP均能有效的反映插管的应激反应,可作为插管时麻醉深度监测的有效指标。AEPindex较其他几项指标更为可靠。

[Objective] To study the relationship between bispectral and auditory evoked pontential change during anesthesia induction intubation with propfol and vecuronium. [Methods] 40 ASA Ⅰ,Ⅱ（18-55year） patients undergoing selective abdominal operations. Anesthesia was induced with 2 mg/kg propfol and 0.1 mg/kg vecuroninm after the endotracheal topical anesthesia with 2%lidocaine. After tracheal intubation, the patients of two groups were ventinated by IPPV in pure oxygen （Vt 6-8 mL/kg, PETCO2 35-40 mmHg）. The timepionts setting for observation were： preanesthesia （T0）, 2 min after induction （T1）, during induction （T2）, 2 min after intubation （T3）, 5 min after intubation （T4）- The changes of mean arterial blood pressure （MAP）, heart rate （HR）, AEPindex and BIS were recorded simultaneously. [Results] Every observation index decreased significantly after induction and increased remarkably after tracheal intubation than that at preanesthesia, however, two values after intubation were still obviously lower than those at preanesthesia. The tendency of hemodynamic changes was similar to that of BIS／EPindex. [Conclusion] SEF,BIS,AEPindex can reflect the stimulus of endotracheal intubation. AEPindex is better than BIS in response to the stimulation of trcheal intubation.