BIS预测切皮心血管反应的可靠性

Evaluation of bispectral index to predict the hemodynamic responses to skin incision

目的 研究脑电双频指数 (BIS)能否预测切皮时心血管反应以及芬太尼对其影响。方法 ASAⅠ～Ⅱ级择期普外和妇科腹部手术病人 4 8例 ,随机分对照和芬太尼两组。以咪唑安定、芬太尼、维库溴铵和丙泊酚顺序麻醉诱导。插管后吸入异氟醚维持麻醉。切皮前 5分钟 ,芬太尼组静注芬太尼 2 μg/kg ,对照组静注等体积的生理盐水。观察切皮前后BIS、心率、收缩压 (SBP)变化及呼气末异氟醚浓度 (ISOET)。结果 (1)麻醉诱导后BIS明显下降 (P <0 0 1) ,静注芬太尼后 ,BIS由4 7 4降至 4 4 3(P <0 0 5 ) ,而注等体积生理盐水 ,BIS则无明显变化。切皮前至切皮后 15分钟 ,ISOET均低于对照组 (P <0 0 5 ,P <0 0 1) ,而BIS值高于对照组。 (2 )BIS值与ISOET呈显著负相关 ,r =- 0 3395 8(P =0 0 0 1) ,而与SBP无相关性。 (3)切皮后 ,对照组心率明显增加 ,而芬太尼组无明显变化 ;SBP两组均较切皮前明显增加 ,但对照组增加幅度更明显。结论 BIS不能预测切皮时的心血管反应 ,芬太尼可显著减轻切皮时的心血管反应 。

Objective To evaluate the capacity of bispectral index (BIS) to predict the hemodynamic responses to skin incision and the effects of fentanyl on it.Methods Forty eight patients,graded ASAⅠ Ⅱ degree undergoing general or gynecologic abdominal surgery,were randomized to placebo or fentanyl group.Anesthesia was induced in all patients with midazolam,fentanyl,vecuronium and propofol in order and maintained with isoflurane.Fentanyl 2μg/kg and placebo (the same volume of saline)were intravenously injected in fentanyl or placebo group at 5 minuteds before skin incision,respectively.BIS, heart rate (HR),systolic blood pressure (SBP) and end expired isoflurane concentration (ISO ET ) were recorded before and after skin incision.Results BIS was significantly decreased after anesthesia induction in both of groups and further decreased from 47 4±8 4 to 44 3±7 5 after administration of fentanyl,but without significantly changes after administration of placebo.BIS were higher and ISO ET was lower in fentanyl group than those in placebo group at before and after skin incision.BIS was highly correlated to ISO ET (coefficient was -0 33958, P= 0 001) and not correlated to SBP.After skin incision,HR was significantly increased in placebo group and insignificantly changed in fentanyl group,but SBP increase in placebo group was much more than that in fentanyl group.Conclusion BIS could not be used to predict the hemodynamic responses to skin incision.Fentanyl doesnt affect BIS value,but alleviates the hemodynamic responses to skin incision significantly. [