丙泊酚TCI与BIS技术应用于神经外科血管内治疗麻醉的临床研究

目的 研究神经外科血管内治疗病人进行神经安定麻醉时，丙泊酚靶浓度控制输注（TCI）的效应室浓度（Ce）变化规律及相应警觉／镇静评分（OAA／S）级别和脑电双频指数（BIS）的变化。方法 对择期行神经外科血管内治疗的63例病人进行TCI。待OAA／S逐次达到5、4、3、2级时，记录相应的心率（HR）、平均动脉压（MAP）、氧饱和浓度（SpO2）、呼吸次数（RR）和BIS，并记录丙泊酚靶浓度（Ct）和Ce。结果 ①Ce变化与Ct变化有较好的一致性。随镇静逐渐加深，OAA／S级别降低，Ct、Ce明显增加（P〈0．05），BIS明显下降（P〈0．05）。②BIS与Ct、Ce呈显著负相关（相关系数r分别为-0．914和-0．925，P〈0．05），OAA／S与BIS呈显著正相关（r=0．934，P〈0．05），OAA／S与Ct、Ce呈显著负相关（r分别为-0．917和-0．919，P〈0．05）。③OAA／S级别下降，HR、MAP、RR和SpO2明显下降（P〈0．05）。结论 麻醉科医生可以选择OAA／S级别或丙泊酚Ce来调定麻醉深度，OAA／S3级（Ct为2．02μg／m1）是神经外科血管内治疗麻醉的最佳选择。

Applicastion of Target Controlled Infusion of Propofol and Bispectral Index to Neuroleptanesthesia during Endovascular Treatment in patients with Cerebrovascular Disease

Objective To investigate the changes in the effect compartment concentration （Ce） of target controlled infusion （TCI） of Propofol and the corresponding assessment of alertness/sedation （OAA/S） and bispectral index（BIS） during neuroleptanesthesia（NLA） in the patients with cerebrovascular disease undergoing endovascular treatment. Methods Propofol was intravenously infused by a TCI system in 63 patients with cerebrovascular disease undergoing endovascular treatment when OAA/S reached respectively levels 5, 4, 3, 2 and 1. The corresponding heart rate（HR）, mean arterial pressure（MAP）, SpO2, respiratory rate（RR）, bispectral index（BIS）, target controlled concentration（Ct and Ce were recorded. Results C, increased with the increase in Ct. BIS, which was positively correlated with OAA/S （r=0.934, P〈0.05）, was correlated significantly and negatively with C, and Ce （r=-0.914 and -0.92, P〈0.05）, which were negatively correlated with OAA/S （r=-0.917 and -0.919, P〈0.05）. With the decrease in the OAA/S score, HR, MAP, RR and SpO2 decreased significantly （P〈0.05）. Conclusions OAA/S score and Propofol Ce can be used to assess the depth of anesthesia during the TCI of Propofol. The 3rd level of OAMS is the best choice for the neuroleptanesthesia during endovascular treatment in the patients with cerebrovascular disease.