肝脏移植手术中麻醉深度的监测

Depth monitoring of anesthesia during operation of liver transplantation

目的:观察肝脏移植麻醉及手术过程中麻醉意识深度指数(CSI)、脑电双频谱指数(BIS)、听觉诱发电位指数(AAI)和强直电刺激-循环反应的变化及其在肝脏移植手术中监测的价值.方法:选择终末期肝病患者20例,麻醉诱导采用异丙酚靶控输注系统(TCI),改良清醒镇静评分(OAA/S)从5分降至0分时,静脉注射维库溴铵0.1 mg/kg,芬太尼2μg/kg,3 min后行气管插管,机械通气.异氟烷吸入维持麻醉.记录OAA/S从5分下降至0分的过程中CSI,BIS和AAI的值.麻醉维持期间,异氟烷呼气末浓度分别为0.5,1.0,1.5MAC时给予强直电刺激(ETS)1次,记录ETS前后各时点的CSI,BIS和AAI值,同时记录ETS后30 s内HR及动态有创血压SP,DP的最高值.结果:CSI,BIS和AAI均能很好地反映肝脏移植手术诱导期间镇静程度及意识的变化,OAA/S评分从5分逐渐降低至0分的过程中,CSI,BIS和AAI值也相应下降(P<0.05).ETS前后各参数比较,CSI和BIS无明显变化(P>0.05),AAI有显著性变化(P<0.05).与ETS前比较,ETS后HR,SP和DP明显增高(P<0.05).结论:CSI和BIS能准确反映镇静状态下患者意识深度的变化,但不能反映镇痛.AAI不仅可以反映麻醉中的镇静成分,而且在监测手术伤害性刺激及镇痛方面亦有一定的意义.强直电刺激-循环反应可以反映术中伤害性刺激.

AIM： To observe the depth of anesthesia in the operation of liver transplantation and the changes of the anesthetic cerebral state index （CSI）, the bispectral index （BIS）, auditory evoked potential index （A-line ARX index, AAI） and the cardiovascular responses to the electrical tetanus stimuli during operation and to evaluate their significance. METHODS： Twenty patients with advanced liver diseases were assigned to target-control injection （TCI） of Propofol on induction of anesthesia. When the assessment of alertness/sedation scale （OAA/S） declined from 5 to 0, intravenous injections of Vecuronium （0. 1 mg/kg） and Fentanyl （2 μg/kg） were administered. Tracheal intubation was performed 3 min later for mechanical ventilation and anesthesia was maintained with Isoflurance inhalation. CSI, BIS and AAI readings were recorded in the process of OAA/S declining from 5 to 0. During the anesthetic maintenance, ETS was applied once at the end-tidal Isoflurance concentration of 0.5, 1.0 and 1.5 MAC respectively. Time point values of CSI, BIS and AAI were recorded before and after ETS. The maximum values of HR and dynamic traumatic SP and DP in 30 min after ETS were also recorded. RESULTS： The values of CSI, BIS and AAI well reflected the changes in the depth of tranquility and consciousness. The values of CSI, BIS and AAI declined （ P 〈 0.05 ） with the scale down of OAA/S values from 5 to 0 during the induction of tranquilization in the liver transplantation operation. No evident difference （P 〉 0.05 ） was found in the indexes of CSI and BIS, but the values of AAI varied significantly （ P 〈 0.05 ） before and after ETS. HR, SP and DP readings obviously rose after ETS compared with that before ETS. CONCLUSION： CSI and BIS accurately reflect the changes in the depth of patients＇ consciousness but not the analgesia in tranquilized state. AAI showing the sedative elements in anesthesia is of some significance in monitoring traumatic stimulation and analgesia in the operation. ETScyclic reaction may reflect the detrimental stimulations.