浅麻醉状态下罗库溴铵与维库溴铵对脑电双频谱指数和脑状态指数的影响

Influence of rocuronium and vecuronium on Bispectral index and cerebral state index during light anesthesia

目的在异丙酚效应室靶浓度2．5ug／ml维持的浅麻醉状态下，比较静脉注射罗库溴铵与维库溴铵对脑电双频谱指数（BIS）和脑状态指数（CSI）的影响。方法择期全麻下手术患者30例，ASAⅠ或Ⅱ级，年龄20～55岁，体重50～80k，采用靶控输注异丙酚（效应室靶浓度4．0ug／m1）联合口咽部表面麻醉，置入喉罩，机械通气，然后将异丙酚效应室靶浓度调整为2．5ug／ml，达到靶浓度后稳定20min（期间对TOF—Guard肌松监测仪进行定标），随机分为3组（n=10）：对照组（C组）静脉注射生理盐水5ml；罗库溴铵组（R组）和维库溴铵组（v组）分别静脉注射2倍E战，剂量的罗库溴铵（0．6mg／kg）和维库溴铵（1mg／kg），待TOF的第1个肌颤搐恢复到10％时停止试验。于给药即刻（T1）、BIS和CSI降到最低值（T2）、试验结束时（T3）记录BIS和CSI。记录罗库溴铵或维库溴铵的肌松起效时间，给肌松药结束至BIS和CSI降到最低值的时间。结果C组各时点BIS和CSI比较差异无统计学意义（P〉0．05）；与L时比较，R组和V组T2时BIS和CSI降低（P〈0．05），L时BIS和CSI差异无统计学意义（P〉0．05）；与B时比较，R组和V组T1时BIS和CSI升高（P〈0．05）；与R组比较，V组起效时间及BIS和CSI降到最低值的时间延长（P〈0．05）。结论浅麻醉状态下，静脉注射2倍ED95剂量的罗库溴铵与维库溴铵后，BIS和CSI均出现先下降再回升的变化，且罗库溴铵对BIS和CSI发挥最大抑制效应的时间较维库溴铵缩短。

Objective To investigate the influence of rocuronium and vecuronium on Bispectral index （BIS） and cerebral state index （CSI） in patients undergoing light general anesthesia maintained with propofol given by TCI with the target effect-site concentration （Ce） set at 2.5 ug/ml. Methods Thirty ASA Ⅰ or Ⅱ patients aged 20-55 yr weighing 50-80 kg undergoing elective surgery under general anesthesia were included in this study. Oral-pharyngeal topical anesthesia was performed with 2% lidocaine. General anesthesia was induced with propofol TCI. When the Ce of propofol reached 4.0ug/ml, Laryngeal mask airway （LMA） was inserted. Ce was then reduced to 2.5 ug/ml. TOF stimulation （TOF, Guard） of ulnar nerve was used to monitor neuron-muscular function. BIS, CSI and vital signs were continuously monitored during the experiment. The patients were randomized into 3 groups （n = 10 each）： control group （group C）, rocuronium group （group R） and vecuronium group （group V） . Group C received normal saline 5 ml and group R and V received 2 times the ED95 of rocuronium and veeuronium respectively. The experiment was concluded when T, returned to 10% of control twitch. Results There was no significant change in BIS and CSI values in group C. BIS and CSI values decreased in the beginning and then rebounded in group R and V. The onset time was shorter in group R than in group V. The time needed for BIS and CSI to reach the lowest value was significantly shorter in group R than in group V. The two groups were similar in the degree of maximal decrease in BIS and CSI. Conclusion During light propofol anesthesia both BIS and CSI values decrease at the beginning and then rebound after a bolus of 2 times the ED95 of rocuronium or vecuronium. The time of the maximal inhibitory effect of rocuronium on BIS and CSI is shorter the that of vecuronium.