复合异丙酚全麻中麻醉深度指标的相关性

目的 探讨复合异丙酚全麻中麻醉深度指标的相关性。方法 选择ASA Ⅰ～Ⅱ择期手术患者18例,行血压、心率、脑电、心率变异性监测,并测定异丙酚血药浓度。调整异丙酚的泵注速度,使收缩压(SBP)的波动幅度≤20％基础值,双频谱指数(BIS)维持在30～60之间。结果 异丙酚血药浓度与BIS、平均动脉压(MAP)有负相关关系(P<0.01),相关程度为BIS>MAP,心率(HR)与MAP呈正相关(P<0.01);心率变异性低频(LF)、高频(HF)与HR均有负相关关系(P<0.01),LF与HF有正相关关系(P<0.01),LF、HF与MAP、BIS、异丙酚血药浓度无相关关系(P>005)。结论 LF、HF可反映心脏交感、迷走张力的活动变化,而不能反映麻醉的意识状态。可通过BIS、平均动脉压来调整异丙酚血药浓度。

The correlation between Parameters used to estimate the depth of anesthesia during combined propofol anesthesia

Objective To estimate the relationship between the parameters used to estimate the depth of anesthesiaMethods Fifty-two ASA I - II patients undergoing choleeystectomy or exploration of eommon bile duet without jaundice were emdled in the study. Premedieation consisted of midazolam 5 mg and atropine 0.5 mg im.30 min before operation. Anesthesia was induced with fentanyl 4 ug.kg-1 , droperidol 0.08 mg.kg-1 , propofol 2 mg. kg-1 and vecuronium 0.1 mg.kg-1 , and maintained with enflurane and continuous infusion of propofol and intermittent intravenous boluses of vecuronium. The patients were intubated and mechanically ventilated. B1S,HRV and BP were continuously monitored and recorded before induction (T1 ) , 1 min(T2 ) , 3 min(T3 ) after intubation, 1 min before skin incision (T4) , 3 min after skin incision (T5), 1 h after induction (T6), 1 min before extubation (T7) and when the patient was conscious (T8). Blood samples were taken at the same intervals for detenninaton of blood propofol and cortisol level (n = 18) by using radioimmunoasscey and HPL, BIS was maintained at 30 ~ 60 during anesthesia by adjustment of propofol infusion rate. Results There was negative correlation between plasma propofol concentration and BIS/MAP; there was positive correlation between HR and MAP. Plasma cortisol level was positively correlated with BIS, MAP and HR and negatively correlated with plasma propofol concentration. Conclusion The LF and HF can reflect the changes in cardiac sympathetic-vagal tension but cannot reflect the depth of anesthesia. Stress response can be controlled by plasma propofol concentration and estimated by BIS,MAP and HR monitoring.