体外循环心脏手术术中影响听觉诱发电位相关因素分析(精选).docVIP

体外循环心脏手术影响AEP)应用于体外循环心脏术病人，CPB)中可能影响AEP的因素。择期心脏瓣膜置换术患者0例咪唑安定、乙咪酯、芬太尼、罗库溴铵麻醉前灌注流量AQ)、灌注压PP)、CVP)、Temp1)、Temp2)对AEP的影响。术后访视病人。结果：麻醉诱导后AEP迅速下降P0.01)，切皮锯胸骨、主动脉插管及转机前AEPP0.05)。CPB期间AEP降低并与心脏鼻温最低时达P0.05)。AEP值上升，时恢复CPB前水平P0.05)。AEP能及时准确的反映体外手术各时期的麻醉镇静深度变化，有效预防术中知晓。，温、灌注压。To analyze the effect of the factor related to CPB on AEP. Methods Twenty ASA Ⅱ~Ⅲ patients undergone elective heart valve replacement were studied. The patients were induced with midazolam, etomidate, fentanyl and rocuronium used for neuromuscular block. Anesthesia was maintained with midazolam, fentanyl by target-controlled infusion(TCI). AEP, MAP, HR were recorded at 14 different time points and the statistics of CPB were also recorded. The patients were visited after recovery from anesthesia. Results AEP was decreased significantly after induction of anesthesia (P0.01). During incision, sternotomy, and aortic cannulation, AEP was increased (P0.05). The decrease in AEP was significantly larger during CPB especially in hypothermia with heart arrest (P0.05). After rewarming and restoring heart beats, AEP began to increase and was elevated to the level before CPB in the end (P0.05). All patients were detected no awareness during operation. Conclusion the depth of anesthesia in cardiac operation with CPB can be monitored promptly and precisely by AEP. Hypothermia, hypotension and non-pulsating perfusion depressed markedly AEP during CPB. 体外循环(CPB)期间术中知晓以及术后中枢神经系统并发症是影响心脏外科手术预后的重要因素之一。听觉诱发电位（auditory evoked potentials, AEP）是继脑电双频指数（Bispectral index, BIS）之后近年来新发展的一个监测麻醉深度的指标，它同时反映皮质和皮质下的电活动具有及时、准确等[特点。AEP应用于体外循环心脏手术国内外报道甚少，本拟对CPB心脏瓣膜置换术病人进行动态AEP监测，并对CPB中诸多可能影响AEP的因素进行分析。 资料和方法 一般资料 择期行心脏瓣膜置换术患者0例，ASA Ⅱ~Ⅲ级，年龄 岁，体重kg，心脏射血分数40%。排除条件：有明显肝、肾、呼吸功能不全；有未控制的高血压；有脑血管意外病史，听力障碍患者。 麻醉方法 术前30min常规肌注吗啡0.2mg/kg、长托宁0.02mg/kg。麻醉诱导采用咪唑安定0.2mg/kg、乙咪酯0.3mg/kg、芬太尼6μg/kg、罗库溴铵0.61.2mg/kg静注，插管后行纯氧机械通气，设定潮气量（VT）8~10 ml/kg，呼吸频率（RR）12~ 次/min，维持呼气末二氧化碳分压（PETCO2）kPa。麻醉维持间断静注维库溴铵，追加咪唑安定芬太尼，带管入ICU监测 病人入手术室后开放下肢静脉。采用公司A-line麻醉深度检测仪