脑电双频谱指数监测下七氟醚吸入对脊柱矫形术中唤醒的影响

目的在脑电双频谱指数(BIS)监测指导下,评价七氟醚吸入对照丙泊酚静脉输注对脊柱矫形术中唤醒试验影响的差别。方法择期行脊柱矫形术患者40例,分为七氟醚组和丙泊酚组,每组20例。诱导插管成功后七氟醚组吸入低流量七氟醚(1L·min-1),丙泊酚组输注丙泊酚4～6mg·kg-1·h-1维持麻醉,2组术中均微泵输注瑞芬太尼0.20～0.50μg·kg-1·min-1。唤醒前七氟醚组停止吸入七氟醚,丙泊酚组停止输注丙泊酚,瑞芬太尼调至0.05～0.15μg·kg-1·min-1,唤醒试验成功后,七氟醚组恢复麻醉气体吸入,丙泊酚组静脉注射丙泊酚1mg·kg-1,手术结束前5min,2组患者停止使用麻醉药,手术结束时停止静脉注射瑞芬太尼。记录2组患者手术开始至唤醒试验的时间、手术时间、唤醒时间(从开始唤醒至唤醒成功时间)及苏醒时间(唤醒后清醒时间);观察唤醒试验期间有无不良反应发生;记录2组麻醉前(T0)、术中唤醒前停药时(T1)、唤醒时(T2)、唤醒后10min(T3)、术毕拔管(T4)时平均动脉压(MAP)、心率(HR)、BIS值及呼吸末七氟醚的浓度(ETsev)。术后1d,随访患者对唤醒试验及术中其他事件的记忆情况及术中有无疼痛等。结果 2组患者均成功完成唤醒试验,均能按照指令活动双侧脚趾和手指。2组患者手术开始至唤醒试验的时间、手术时间、唤醒时间和苏醒时间比较差别均无统计学意义(P>0.05)。唤醒期间丙泊酚组有1例发生呛咳,七氟醚组无发生呛咳患者。术后随访2组患者无神经损伤表现,对术中其他事件无记忆。术中2组患者唤醒试验唤醒时(T2)及术毕拔管时(T4)的MAP和HR值较其他时间点均明显升高(P<0.05);2组患者在唤醒前停药时(T1)及唤醒后10min(T3)的BIS值较其他时间点均明显降低(P<0.05);七氟醚组在唤醒前停药时(T1)及唤醒后10min(T3)的ETsev值较其他时间点升高(P<0.05);2组各时间点的MAP、HR及BIS值比较差别无统计学意义(P>0.05)。结论脊柱矫形术麻醉中在BIS监测指导下吸入七氟醚同丙泊酚一样适用于脊柱矫形术;BIS监测对脊柱矫形术中唤醒时间有预测和指导作用。

Effect of inhalational sevoflurane guided by bispectral index monitoring on intraoperative wake-uptest in patients undergoing scoliosis orthomorphia surgery

Objective To evaluate the differences between the effects of sevoflurane and propofol under bispectral index ( BIS) monitoring in intraoperative wake-up test. Methods Fourty patients with scoliosis orthomorphia surgery were randomly divided into sevoflurane group ( n = 20) and propofol group ( n = 20). Anesthesia was maintained with low -flow ( 1 L·min -1 ) inhalation of sevoflurane in sevoflurane group and propofol ( 4 -6 mg·kg -1 ·h -1 ) in propofol group. Remifentanil ( 0. 20 -0. 50 μg· kg -1 · min -1 ) was infused in two groups. Sevoflurane and propofol were stopped respectively before wake-up and remifentanil was turned down to 0. 05 -0. 15 μg·kg -1 ·min -1 ; Sevoflurane and propofol( 1 mg·kg -1 ) were recovered after wake-up test succeeding. Anaesthetic were disused in two groups at 5 minutes before operation completed. Remifentanil was stopped when the operation was over. The time from starting of operation to wake-up test,operation time,wake-up test time,an-alepsia time was recorded. Mean arterial blood pressure( MAP) ,heart rate( HR) ,BIS and end-tidal sevoflurane ( ETsev) were recorded at before anaesthesia( T0 ) ,drug stopped before wake-up( T1 ) ,wake-up( T2 ) ,10 minutes after wake-up( T3 ) and extu-bate( T4 ). Retention condition about the wake-up test and other intraoperative events were follow-up visited at 1 day after operation. Results All patients in two groups woke up successfully,all could move toes and fingers. The differences of the time from starting of operation to wake-up test,operation time,wake-up test time,analepsia time between two groups were not statistically significant( P > 0. 05). One case of bucking was in propofol group,while sevoflurane group without one. All patients could not recall the wake-up test and other intraoperative events. During the operation,MAP and HR at T2 and T4 were higher than those at other time ( P < 0. 05) ,while BIS were lower at T1 and T3 in two groups( P < 0. 05). Etsev at T1 and T3 were higher than those at other time in sevoflurane group( P < 0. 05). The differences of MAP,HR and BIS at all times between two groups were not statistically significant( P > 0. 05). Conclusion Both sevoflurane inhalation anesthesia and propofol are appropiate anesthetic skills for scoliosis orthomorphia. BIS may be a useful clinical monitor to predict and guide wake-up test time.