听觉诱发电位指数在神经外科介入治疗中的应用

目的探讨听觉诱发电位指数（AAI）、靶控输注及喉罩应用于神经外科介入治疗的可行性及有效性。方法将40例ASAⅡ-Ⅲ级，动脉瘤分级Ⅱ～Ⅳ级接受神经外科介入治疗全身麻醉的患者随机分为A、B两组，每组20例，两组均应用丙泊酚靶控．瑞芬太尼-阿曲库铵静脉维持麻醉，插入喉罩进行机械通气。A组为AAI指导组，通过维持AAI值于20～25来调节丙泊酚的靶浓度值；B组为对照组，凭借血流动力学参数来调节丙泊酚的靶浓度值。记录麻醉期间血流动力学及AAI的变化、麻醉药物用量、术毕清醒时间、拔管时间及有无发生术中知晓。结果40例患者均安全顺利经过介入治疗过程，两组患者血流动力学指标及术毕拔管时间差异无统计学意义（P〉0．05），A组丙泊酚用量及术毕清醒时间少于B组（P〈0．05），两组均未发现术中知晓。结论AAI作为一项新的麻醉深度监测指标可被有效地应用于神经外科介入治疗全麻监测，实现给药个体化，提高麻醉安全性，减少术中知晓的发生率。

Using Auditory Evoked Potential Index in Neurosurgical Endovascular Treatment

Objective To investigate the effectiveness and feasibility of using auditory evoked potential index（AM）, target-controlled infusion（TCI） and laryngeal mask airway（LMA） in neuresurgical endovascular treatment. Methods 40 patients（ ASA Ⅱ-Ⅲ , aneurysm degree Ⅱ-Ⅳ ）, who were undergoing neurosurgical endovascular treatment under general anesthesia were randomly divided into two groups（ n = 20 each）, all the pationts were maintained anesthesia with propofol-remifentanil-atracurium by TCI, LMA to administer mechanical ventilation, Group Ⅰ （ AAI group）, adjusted TCI concentration of propofol by maintaining AAI from 20 to 25; Group Ⅱ （ control gToup）, according to hemodynamic data to adjust TCI concentration of propofol. All the following data were recorded, such as hemodynsmic data, AM, the dosage of anesthetic drug, awaked time and the time of extubated LMA after operation, whether happened awareness during operation. Results The operations on all patients were successful. There were no differences between two groups on hemedynomic data and the time of extubated LMA after operation （ P 〉 0.05）. The dosage of propofol and awaked time after operation of group Ⅰ were lower than that of group Ⅱ （ P 〈 0.05）. There was no awareness happening during operation. Conclusion As a new reference of measuring the depth of anesthesia, AAI can be effectively used during general anesthesia for the operation of endovascular embolization in intracranial aneurysms, to achieve medication individually, elevate the safety of anesthesia and reduce awareness rate during operation.