不同剂量艾司氯胺酮对咪达唑仑镇静患者脑电双频指数的影响

Effect of different doses of esketamine on bispectral index in patients sedated with midazolam

目的探讨不同剂量艾司氯胺酮对咪达唑仑镇静患者脑电双频指数(BIS)的影响。方法选择行择期全身麻醉手术的患者51例,随机分为3组:对照组(C组)、艾司氯胺酮0.25 mg·kg^(-1)组(E1组)和艾司氯胺酮0.5 mg·kg^(-1)组(E2组),每组17例。给予患者咪达唑仑静脉注射(静注)5 min后,E1组、E2组分别静注艾司氯胺酮0.25和0.5 mg·kg^(-1),C组给予等容量氯化钠注射液。观察并记录3组咪达唑仑静注前(T_(0))、咪达唑仑静注后5 min(T_(1))、艾司氯胺酮或氯化钠注射液静注后5 min(T_(2))、10 min(T_(3))的BIS值、肌电信号(EMG)值、心率(HR)、平均动脉压(MAP),和改良警觉/镇静评分(MOAA/S)。结果与T_(1)时比较,E1组和E2组T_(2)、T_(3)时BIS值升高(P<0.05),C组无明显变化(P>0.05);与C组比较,E1组T_(2)和T_(3)时、E2组T_(3)时BIS值较高(P<0.05);E2组T_(2)时BIS值低于E1组(P<0.05)。与T_(1)时比较,3组T_(2)、T_(3)时EMG值均无明显变化(P>0.05)。与T_(1)时比较,E1组T_(2)时、E2组T_(2)和T_(3)时HR升高,E1组和E2组T_(2)、T_(3)时MAP升高(P<0.05);与C组比较,E1组T_(2)时、E2组T_(2)和T_(3)时HR较高(P<0.05),E2组T_(2)和T_(3)时MAP较高(P<0.05);E2组T_(3)时MAP高于E1组(P<0.05)。E1组和E2组T_(2)、T_(3)时MOAA/S均较T_(1)时降低(P<0.05),且T_(2)和T_(3)时E1组、E2组MOAA/S均较C组低(P<0.05)。结论艾司氯胺酮0.25和0.5 mg·kg^(-1)均可使咪达唑仑镇静患者镇静评分降低而BIS值升高,不同剂量艾司氯胺酮对BIS的影响不同。

AIM To investigate the effect of different doses of esketamine on bispectral index(BIS)in patients sedated with midazolam.METHODS A total of 51 patients who scheduled for elective general anesthesia operation were randomly divided into three groups(n=17 in each group):control group(group C),esketamine 0.25 mg·kg^(-1) group(group E1)and esketamine 0.5 mg·kg^(-1) group(group E2).After midazolam sedation,the patients in the group E1 and group E2 were received an intravenous infusion dose of esketamine 0.25 and 0.5 mg·kg^(-1) respectively,and the equal volume of sodium chloride injection was given in the group C.BIS,electromyography(EMG),heart rate(HR)and mean arterial pressure(MAP)were recorded before midazolam administration(T_(0)),5 min after midazolam injection(T_(1))and 5 min(T_(2)),10 min(T_(3))after esketamine or sodium chloride injection administration,and modified observer’s assessment of alertness/sedation(MOAA/S)score was assessed at T_(0),T_(1),T_(2) and T_(3).RESULTS Compared with that at T_(1),BIS at T_(2),T_(3) in the group E1 and group E2 increased(P<0.05).Compared with those in the group C,BIS at T_(2),T_(3) in the group E1 and at T_(3) in the group E2 increased(P<0.05).Compared with that in the group E1,BIS at T_(2) in the group E2 decreased(P<0.05).Compared with that at T_(1),there was no significant difference of EMG in three groups at T_(2) and T_(3)(P>0.05).Compared with that at T_(1),HR at T_(2) in the group E1 and T_(2),T_(3) in the group E2 increased respectively(P<0.05),MAP at T_(2),T_(3) increased in the group E1 and the group E2(P<0.05).Compared with that in the group C,HR at T_(2) in the group E1 and T_(2),T_(3) in the group E2 increased respectively(P<0.05),MAP at T_(2) and T_(3) increased in the group E2(P<0.05).Compared with that in the group E1,MAP at T_(3) increased in the group E2(P<0.05).Compared with that at T_(1),MOAA/S score at T_(2),T_(3) decreased in the group E1 and the group E2(P<0.05).Compared with that in the group C,MOAA/S score at T_(2),T_(3) decreased in the group E1 and the group E2(P<0.05).CONCLUSION Esketamine 0.25 and 0.5 mg·kg^(-1) can decrease the sedation scores but increase the BIS values,and the effect of different doses of esketamine on BIS is different.