咪唑安定复合异丙酚对腹腔镜手术脑电双频指数的影响

目的：观察不同血浆靶控浓度异丙酚全麻时腹腔镜手术脑电双频指数（BIS）的变化。方法：选择ASAⅠ～Ⅱ级在气管插管全麻下行简单妇科腹腔镜手术的患者48例,按异丙酚靶控浓度随机分为A组（3.3μg/ml）、B组（3.5μg/ml）、C组（3.7μg/ml）、D组（3.9μg/ml）四组,每组12例。入室后测量BIS、MAP、HR、SPO2作为基础值。麻醉诱导时按既定的靶控浓度输注异丙酚,缝皮结束时停药。记录插管前,插管1、5min,切皮时,术中5、10、20、30min,停药时,拔管后5min的BIS值;拔管的时间及BIS值、清醒时血药浓度。结果：异丙酚靶控浓度在3.5、3.7μg/ml时手术能保持BIS维持在40～60范围内,3.9μg/ml术中维持时麻醉深度偏高,而3.3μg/ml在诱导时麻醉深度偏低。结论：咪唑安定复合异丙酚用于妇科腹腔镜手术药物血浆浓度变异较大,麻醉诱导＋维持时血浆浓度以3.5、3.7μg/ml合适,可以使用最低为3.3μg/ml血浆浓度作为术中维持用药。

Effects of Midazolam combined with Propofol on bispectral index for laparoscoplc surgery

Objective：To observe the changes of bispectral index（BIS）under different target-controlled plasma concen-trations of Propofol during laparoscopic surgery anesthesia.Methods：48 patients,ASA Ⅰ～Ⅱlevel,under endotracheal intubation anesthesia during gynecologic laparoscopic surgery,were divided into 4 groups randomly according to the concentration of Propofol.The concentration of group A,B,C,D were 3.3,3.5,3.7,3.9 μg/ml respectively,12 cases each group.Then BIS,MAP,HR,SPO2 were measured as the basic value.Propofol was injected in accordance with established target-controlled concentration during induction of anesthesia,and withdrawal at the end of skin sewing.The value of BIS was recorded before intubation,after intubation 1 and 5 minites,skin incision,5,10,20,30 min during the surgery,the time stop injection and 5 min after extubation.Extubation time,the BIS value,and blood concentration of Propofol when the patient become awake also recorded.Results：BIS value can be maintained at 40-60 when target-controlled concentration of Propofol was 3.5 μg/ml and 3.7 μg/ml,while the depth of anesthesia become high at the concentration of 3.9 μg/ml and low at the concentration of 3.3 μg/ml during the induction of anesthesia.Conclusion：The plasma concentration of Midazolam combined with Propofol varies much when used in laparoscopic surgery anesthesia.It is appropriate to use anesthesia induction plus maintenance plasma concentration at 3.5 μg/ml and 3.7 μg/ml,as low as 3.3 μg/ml can be used as maintenance dose during the surgery.