听觉诱发电位指数用于监测不同靶浓度依托咪酯诱导期间麻醉深度的评价

Application of AAI in Monitoring the Depth of Anesthesia During Induction with Target Controlled Infusion Etomidate

目的观察不同靶浓度依托咪酯麻醉诱导期间听觉诱发电位指数(AAI)的变化,分析其对麻醉深度监测的临床意义。方法选取择期行全身麻醉下非心脏手术患者80例,ASA分级Ⅰ或Ⅱ级,年龄25~50岁,体重指数<30 kg/m2。采用随机数字表法,将患者随机分为4组,每组各20例,即E0.5组、E0.7组、E0.9组、E1.1组,依托咪酯效应室靶浓度分别为0.5μg/mL、0.7μg/mL、0.9μg/mL、1.1μg/mL。静脉注射咪哒唑仑0.05 mg/kg、芬太尼3μg/kg、罗库溴铵0.6 mg/kg后,开始靶控输注依托咪酯,当效应室浓度达到0.5μg/mL、0.7μg/mL、0.9μg/mL、1.1μg/mL时行气管插管,于麻醉诱导前(T0)、气管插管前(T1)、喉镜置入时(T2)、气管插管后1 min(T3)、气管插管后3 min(T4)、气管插管后5 min(T5)记录平均动脉压(MAP)、心率(HR)、AAI、脑电暴发性抑制指数(BS)。结果 4组患者麻醉诱导期间AAI的变化趋势一致,靶控输注依托咪酯后AAI值明显下降,T1时AAI值明显低于T0时(P<0.01),随后各时点AAI组内、组间比较差异无统计学意义(P>0.05)。T1时MAP、HR明显低于T0时(P<0.01),T2、T3时MAP、HR比T1时明显升高(P<0.05),E0.9组和E1.1组部分患者出现BS,E1.1组BS的发生率明显高于其他组(P<0.05)。结论 AAI能反映靶控依托咪酯麻醉诱导期间麻醉深度的变化,但不能敏感地反映不同靶浓度依托咪酯的麻醉深度。

Objective To investigate the effect of different target effect - site concentration of etomidate on auditory evoked potential in- dex in patients during induction of general anesthesia. Methods 80 ASA I or ]I patients from 25 to 50 years old with body mass index 〈 30 kg/m2 undergoing operations performed under general anesthesia were randomly divided into 4 groups of target effect - site etomiadate concentrations （n = 20 ） ：group E0. 50. 5 p^g/mL group, E0. 70. 7 p^g/mL, group E0.90. 9 p^g/mL and group El. 11. 1 p,g,/mL. The patients were unpremedicated. Anesthesia was induced with midazolam 0. 05 mg/kg, fentany] 3 p^g/kg, rocuronium 0. 6 mg/kg and etomiadate given by TCI . When the effect - site concentration of etomiadate reaches 0. 5,0. 7,0. 9 and 1.1 p,g/mL, endotraeheal intubation was performed. MAP, HR, AAI and EEG burst suppression （BS） were continuously monitored during anesthesia and recorded before induction of anesthesia （baseline）, immediately after TCI, immediately after intubation, 1 min after intubation, 3 min after intubation and 5 min after intuba- tion. Results Alter etomiadate TCI, MAP, HR and AAI was decreased significantly as compared with those before induction （ P 〈 0.01 ）. Changes of AAI points at each phase were similar among the four groups （P 〉 0. 05 ）. MAP and HR at immediately after intubation and 1 min after intubation were higher than those immediately after TCI. The incidence of BS were significantly higher in group El. 1 than in group E05 and group E07- Conclusion AAI can be used for the anesthesia depth monitoring during tracheal intubation, but it can not re- flect the depth of anesthesia sensitively with different target effect - site concentration of etomidate.