丙泊酚在不同靶控浓度下罗库溴铵对脑电双频指数的影响

Influence of rocuronium on bispectral index during different effect-site concentration of propofol

目的探讨丙泊酚在不同靶控浓度下罗库溴铵对脑电双频指数(BIS)监测麻醉深度的影响。方法 ASAⅠ或Ⅱ级择期手术患者60例,随机均分为四组:用于观察的R2组和R3组和用于对照的C2组和C3组。设定丙泊酚初始效应室浓度(Ce)为4.0μg/ml,当患者镇静警觉(OAA/S)评分≤1分时置入喉罩,机械通气,调节丙泊酚靶控浓度,使Ce分别维持在2.0μg/ml(R2、C2组)和3.0μg/ml(R3、C3组),达到靶浓度后稳定20min,观察组静注2倍ED95剂量的罗库溴铵0.6mg/kg,对照组注射生理盐水5ml。记录丙泊酚诱导前即刻(T1)、静脉注射罗库溴铵或生理盐水即刻(T2)、TOF消失为0时(T3)、TOF的第一个肌颤搐恢复到5%时(T4)的BIS、HR、MAP。结果与T1时比较,T2～T4时BIS明显降低(P<0.05);与T2时比较,T3、T4时R2组BIS值明显下降(P<0.05);在不同的丙泊酚Ce下,T2～T4时R2、C2组的BIS明显高于相对照的R3、C3组(P<0.05)。结论罗库溴铵对BIS的影响与镇静深度有关,丙泊酚靶控浓度维持在较浅的镇静状态下,静脉注射2倍ED95剂量的罗库溴铵可引起BIS下降,但在较深的镇静状态下无明显影响。

Objective To investigate whether rocuronium could affect bispcetral index during different effect-site concentration of propofol.Methods Sixty ASA Ⅰ or Ⅱ patients undergoing elective surgery were enrollded in the study,based on Ce of propofol,the patients randomly divided into four groups with 15 cases in each group （group R2 and R3） and （group C2 and C3）.When the Ce of propofol reached 4.0 μg/ml and OAA/S score was below one,a laryngeal mask airway was inserted,Ce was then maintained at 2.0 μg/ml or 3.0 μg/ml for 20 min. Rocuronium of 0.6 mg/kg about 2ED95 was given in groups R2 and R3,normal saline in the volume of 5 ml was given in the other two groups. BIS、HR and MAP values were recorded before induction of propofol immediately（T1）,at the time of injection rocuronium or normal saline（T2）,when TOF reached 0（T3） and at the first TOF twitch of muscle recovered to 5% （T4）. Results The BIS at T3and T4were significantly lower than that at T2in group R2,but not in group R3,C2 or C3. Compared with the same Ce,there was no significant difference between group R2,C2 and group R3,C3. Conclusion Rocuronium could reduce the BIS scores in moderately sedated patients but not in deeply sedated patients.