比较不同麻醉方式下二氧化碳气腹对脑电双频指数的影响

Compare Influence of Carbon Dioxide Pneumoperitoneum on Bispectral Index under Different Methods of Anesthesia

目的观察智能臂辅助腹腔镜前列腺根治手术中不同麻醉方式下二氧化碳气腹对脑电双频指数的影响,从而探讨不同麻醉方式下二氧化碳对麻醉深度的影响。方法选择智能臂辅助腹腔镜前列腺根治手术在全凭静脉靶控麻醉下30例,在七氟醚麻醉下30例,采用随机对照方法,ASA Ⅰ～Ⅱ级,气腹时间〉3h,观察并记录气腹前时间点以及气腹后10、30、60、90、120、180min呼气末二氧化碳（PETCO2）、脑电双频指数（bispectral index,BIS）、平均动脉压（MAP）、心率（HR）和血氧饱和度（SpO2）。术中采用容量控制机械通气模式,根据PETCO2调整呼吸参数,使PETCO2不超过60mmHg。结果PETCO2与BIS采用线性回归方程分析,全凭静脉靶控麻醉下PETCO2与BIS呈正相关（r=0.774,P=0.000）;七氟醚麻醉下PETCO2与BIS之间也呈正相关（r=0.551,P〈0.01）。患者同一麻醉方法不同时间点的MAP、HR采用重复测量方差分析,差异无统计学意义（P〉0.05）。全凭静脉靶控麻醉下和七氟醚麻醉下对应时间点的MAP、HR、PETCO2采用成组t检验,差异无统计学意义（P〉0.05）。结论全凭静脉靶控麻醉下二氧化碳气腹可明显影响BIS值,七氟醚麻醉下二氧化碳气腹对BIS值也有影响。

Objective To observe influence of carbon dioxide pneumoperitoneum on bispectral index during robot-assisted laparoscopic radical prostatectomy surgery with different methods of anesthesia so as to explore the impact of carbon dioxide on the depth of anesthesia under different ways of anesthesia. Methods Thirty cases of robot-assisted laparoscopic radical prostatectomy surgery was selected under total intravenous anesthesia with target controlled infusion, besides, 30 cases of robot-assisted laparoscopic radical prostatectomy surgery was selected through sevoflurane anesthesia. Randomized controlled method was used in this study. ASA I-Ⅱ grade, pneumoperitoneum time〉3 h. bispectral index, mean arterial pressure, heart rate, oxygen saturation and end-tidal carbon dioxide was ecorded before pneumoperitoneum and at each time point of 10, 30, 60, 90, 120 and 180 minutes after pneumoperitoneum. Volume control ventilation mode was used during intraoperative, respiratory parameters was adjusted to keep PETCO2 less than 60mmHg. Results Linear regression analysis showed there was a positive correlation between PETCO2 and BIS by total intravenous anesthesia with target controlled infusion, and r was 0.774（P=0.000）,there also existed a positive correlation between BIS and PETCO2 through sevoflurane anesthesia,r was 0.551（P〈0.01）. Different time points of Mean arterial pressure（MAP）, heart rate （HR） on patients with the same anesthesia showed no statistical significance by repeated measures analysis of variance （P〉0.05）.Compared MAP,HR, PET CO2 on corresponding time between total intravenous anesthesia and sevoflurane anesthesia by group t test showed no statistical significance（P〉 0.05）. Conclusion Carbon dioxide caused by pneumoperitoneum can affect BIS value not only with target-controlled total intravenous anesthesia, but also with sevoflurane anesthesia.