复合异丙酚时不同靶浓度瑞芬太尼对神经外科手术患者脑电双频谱指数的影响

目的 探讨复合异丙酚时不同效应室靶浓度瑞芬太尼对神经外科手术患者脑电双频谱指数(BIS)的影响.方法 择期拟行额颞部开颅手术患者15例,年龄18～64岁,体重50～85 kg,ASA Ⅰ或Ⅱ级.先靶控输注异丙酚,效应室靶浓度为3μg/ml,效应室浓度达预设浓度后靶控输注瑞芬太尼,效应室靶浓度分别为2、3、4、5、6、7、8 ng/ml,效应室浓度依次达预设浓度时记录血压(BP)、平均动脉压(MAP)、心率(HR)和BIS.瑞芬太尼效应室浓度达5 ng/ml时行气管插管和机械通气,于气管插管前即刻和气管插管后即刻记录BP、MAP、HR和BIS.结果 与基础值比较,异丙酚效应室浓度3μG/ml 和瑞芬太尼不同效应室浓度时BIS降低(P<0.05或0.01);与异丙酚效应室浓度3μg/ml时比较,瑞芬太尼效应室浓度≥6 nG/Ml时BIS降低(P<0.05或0.01).结论 复合异丙酚时靶控输注瑞芬太尼效应室浓度≥6 ng/ml时可降低神经外科手术患者的BIS.

Effects of different target concentrations of remifentanil when combined with propofol on BIS in patients undergoing neurosurgery

Objective To investigate the effects of different target concentrations of remifentanil when combined with propofol on BIS in patients undergoing neurosurgery. Methods Fifteen ASA Ⅰ or Ⅱ patients, aged 18-64 yr, weighing 50-85 kg, scheduled for intracranial surgery, were involved in this study. The patients received propofol by target controlled infusion (TCI) at a target effect site concentration (Ce) of 3μg/ml. TCI of remifentanil was started after TCI of propofol reached the preset Ce and Ce of remifentanil was increased step by step from 2 ng/ml to 3, 4, 5, 6, 7 and 8 ng/ml. Invasive BP, MAP, HR and BIS were continuously monitored and recorded when remifentanil reached the each preset Ce. Vecuronium 0.1 mg/kg was injected iv when Ce of remifentanil reached 5 ng/ml, and then the patients were intubated and mechanically ventilated 3 min later. The changes in BP, MAP, HR and BIS were recorded. When HR < 50 bpm and/or MAP < 60 mm Hg, TCI of remifentanil was stopped and iv atropine or ephedrine was given. Results BIS was significantly decreased after TCI of remifentanil when propofol reached 3 μg/ ml compared with the baseline value ( P < 0.05 or 0.01). BIS was significantly decreased when Ce of remifentanil ≥6 ng/ml compared with that when propofol reached 3 μg/ml ( P < 0.05 or 0.01) .Conclusion Low-concentration of remifentanil when combined with propofol has no effect on BIS, but when Ce of remifentanil≥ 6 ng/ml, BIS is obviously decreased.