用脑电双频指数全凭静脉麻醉深度的探讨-中华医学会麻醉学分会.DOCVIP

PAGE PAGE 1 用脑电双频指数评估全凭静脉麻醉深度的探讨 李蕾 程庆好 孙磊 王彬 蔡垣星 刘彬 （煤炭总医院麻醉科 北京 100028） 摘要 目的：腹腔镜手术中通过脑电双频指数和血流动力学的变化来评估全凭静脉麻醉深度。 方法：60例行择期腹腔镜手术的患者，ASA I或II级，男16例，女44例，年龄20-60岁，通过静脉诱导后，泵注丙泊酚和瑞芬太尼，术中间断追加肌松药。术中通过血流动力学变化调整麻醉用药。观察并比较麻醉前（基础值）、气管内插管后、气腹时、手术开始后10分钟、手术开始后30分钟、手术结束时、拔管时的平均动脉压、心率、脑电双频谱指数。结果：气管内插管后BIS下降明显，BIS值为34.38.5；气腹时BIS升高，BIS值为59.711.4，其中有13人BIS高于60，最高为74。术中BIS值维持比较稳定，手术结束时BIS值升高，有16人BIS值高于60，最高78。术后随访时有做梦患者1例。结论：在腹腔镜手术中，经验的全凭静脉麻醉在患者气管插管后到气腹时存在麻醉减浅现象。 关键词 麻醉，静脉；脑电描记术; 血流动力学；腹腔镜 Changes of bispectral index undergoing laparoscopy Li Lei, Cheng Qing-hao，Sun Lei, et al Department of Anesthesiology, Coal General Hospital, Beijing 10028, China Abstract Objective Using bispectral index and physiologic monitoring for depth of IV anesthesia in patients undergoing laparoscopy. Methods Sixty patients of ASA grade I or II aged 20-60 yr undergoing laparoscopy. After IV induction, Anesthesia was maintained by continuous propofol and remifentanil infusions. Muscle relaxations were used if necessary. According to the changes of physiologic monitors, the infusion rate was adjusted. BIS value, MAP and HR were recorded before anesthesia, after endotracheal intubation, co2 pneumoperitoneum, 10mins and 30mins after operation, end of operation, extubation. Results The BIS value decreased significantly after intubation(p0.05); BIS increased when pneumoperitoneum. During the whole operation, BIS value maintained stable. At the end of operation, the BIS value was higher than intubation. After operation, one patient said she had a dream in the operation. Conclusion During the laparoscopy,the experienced TIVA may lead light anesthesia during intubation and pneumoperitoneum. Key words TIVA; Electroencephalography； Monitoring, physiologic；laparoscopy 全凭静脉麻醉中，随着肌松药的应用，对于很多创伤小，时间短的手术中可能存在麻醉较浅的情况。本研究利用脑电双频谱指数（bispectral index，BIS）对全凭静脉麻醉的深度进行监测，与血流动力学指标进行比较，以期在保持血流动力学稳定的同时，减少术中知晓的发生。 资料与方法 一般资料 选择60例行腹腔镜手术的患者，ASA I或II级，男16例，女44例，年龄20-60岁，体重50-80kg。入室后平卧，开放静脉，连接各种监测电极。用EEG M1034A数量化脑电图监测仪（P