切皮刺激对地氟醚麻醉病人数字脑电图及血液动力学的影响

Effects of skin incision on quantitative electroencephal ogram and hamodynamics in patientsanesthetized with desflurane

目的 :观察不同地氟醚麻醉深度下切皮刺激后数字脑电图 (QEEG)及血液动力学变化 ,评价两者用于监测地氟醚麻醉深度的可行性。方法 :2 4例择期腹部手术患者 ,随机分成三组 ,以异丙酚、维库溴铵诱导气管内插管后控制呼吸并吸入地氟醚 ,呼气末地氟醚浓度分别维持在 0 .8MAC(A组 )、1.0 MAC(B组 )或 1.5 MAC(C组 ) ,稳定 15分钟后切皮。记录麻醉前、插管后 6 min、切皮前及切皮后 2 min时平均动脉压 (MAP)、心率 (HR)、双频谱指数 (BI)、95 %边缘频率谱 (SEF)、中间频率谱 (MF)等。结果 :随着呼气末地氟醚浓度的增加 ,BI、SEF、MF显著降低 ,呈线性负相关 ;呼气末地氟醚浓度达 1.5 MAC时 ,MAP显著下降 ,HR亦增快约 14.5 % (但无统计学差异 )。切皮后与切皮前比较 ,A组BI、SEF、MF、MAP、HR显著增加 ;B组 BI显著增加 ;而 C组上述各参数无一发生显著变化。结论 :QEEG可用于地氟醚麻醉深度监测 ,MAP、HR不是地氟醚麻醉时理想的麻醉深度监测指标。

Purpose: To observe the effcts of skin incision on quantitative electroencephalogram(QEEG) and hemodynamics in patients anesthetized with desflurane. Method: 24 patients scheduled for elective abdominal surgery were randomly divided into three groups. Anesthesia was induced with propofol 、vecuronium,after tracheal intubation the lungs were ventilated with desflurane in oxygen. End-tidal desflurane concentration was maintained respectively at 0.8 MAC(group A ),1.0 MAC (group B ) or 1.5 MAC (group C) for 15 minutes before skin incision.Record bispectral index(BI),95% spectral edge frequency(SEF),median frequency(MF),mean artery pressure(MAP),heart rate(HR) at four time points: pre-anesthesia,six minutes after tracheal intubation, before incision and two minutes after incision. Results: Desflurane decreased BI,SEF ,MF in a negative dose-related manner,when the end-tidal desflurane concentration increased from reached 1.5 MAC,MAP was significantly decreased and HR was increased by 14.5%(but there wasn't statistic significance) compared with preanesthesia. After incision,BI,SEF,MF, MAP,HR were significantly increased in group A, BI was significantly increased in group B,while in group C there was no significant change in all parameters. [WT5”HZ]Conclusion: QEEG can be used for monitoring depth of desflurane anesthesia,MAP and HR are not the ideal monitoring indices during desflurane anesthesia.