脑功率谱和心率变异性联合用于麻醉深度监测的临床评价

Clinical Study on Anesthesia Depth Monitoring by Combination of BIS,95% SEF and Heart Rate Variability Following Co induction of Propofol and Midazolam

目的 :联合应用脑功率谱和心率变异性监测异丙酚、咪唑安定及其复合诱导时的麻醉深度 ,观察伤害刺激对脑功率谱和HRV的影响。方法 :ASAⅠ～Ⅱ级 ,全麻下择期手术的成年病人 30例 ,按诱导用药不同随机分为三组 ,组Ⅰ异丙酚 2mg/kg ;组Ⅱ咪唑安定 0 0 5mg/kg加异丙酚 1 5mg/kg;组Ⅲ咪唑安定 0 2mg/kg。按各组用药分别静注异丙酚、咪唑安定或两药前后合用 ,1分钟后静注芬太尼 ,然后给予挤捏斜方肌痛刺激并静注琥珀胆碱作气管插管 ,5分钟后吸入 1 %异氟醚 30分钟开始手术。观察麻醉诱导后、挤捏斜方肌、气管插管、吸 1 %异氟醚 30分钟及切皮时BIS、95 %SEF、HRV、BP和HR的变化。结果 :诱导后各组BIS、95 %SEF均明显降低 ,以组Ⅱ最显著 ,组Ⅲ降低相对较少 ,与组Ⅰ、组Ⅱ比较P <0 0 5 ,挤捏斜方肌、气管插管后组Ⅲ的BIS、95 %SEF升高。诱导后三组HRV均明显下降 ,虽然组Ⅰ挤捏斜方肌、气管插管及切皮后脑功率谱未见显著改变 ,但HRV各成分及血压均显著增高 ,以LF和TP在气管插管时升高为显著。而组Ⅱ除切皮时有升高外 ,未见受其他刺激显著影响。结论 :联合应用脑功率谱和HRV监测麻醉深度可较好地反映全麻病人中枢神经的抑制程度及植物神经系统对外科手术等伤害刺激的反应性 ,可更加合理地评价麻醉深度。异丙?

Objective:To monitor anesthesia depth by combination of BIS,95%SEF and heart rate variability following co induction of propofol and midazolam and investigate the effects of noxious stimulation on BIS、95%SEF of electroencephalogram and heart rate variability(HRV).Method:30 ASAⅠ～Ⅱ adult patients,undergoing elective surgery under general anesthesia were randomly devided into three groups,i.e.group Ⅰ:propofol 2mg/kg intravenously;group Ⅱ:0 05mg/kg midazolam combined with propofol 1 5mg/kg intravenously;group Ⅲ:midazolam 0 2mg/kg intravenously.Anesthesia was induced with a bolus injection of propofol,midazolam or combination of two drugs according to the protocol and a bolus of fentanyl(4μg/kg) in three groups.The trapezius muscle squeeze was applied,and tracheal intubation was performed after a bolus injection of succinylcholine 1 5mg/kg.Five min after intubation isoflurane was inhalated for 30 min BIS,95%SEF,HRV,BP and HR were studied following induction during trapezius muscle squeeze and intubation at 30 min following inhalation of isoflurane and incision.Results:Both BIS and 95%SEF were decreased markedly following induction in three groups.Compared with other groups,in group Ⅲ BIS and 95%SEF decreased significantly( P< 0 05).Trapezius muscle squeeze and intubation could increase the lowered BIS and 95%SEF.All frequency components of HRV also significantly were reduced after induction in all groups,but in group Ⅰ and group Ⅲ the inhibited frequency components of HRV were increased during trapezius muscle squeeze, intubation and incision,especially for LF and TP during intubation.Conclusion:Monitoring anesthesia depth by combination of BIS,95%SEF and heart rate variability can strongly predict patients′ CNS depression and reaction to noxious stimulation.Co induction of propofol and midazolam inhibits the effects of noxious stimulation on BIS and 95%SEF of electroencephalogram and heart rate variability.