罗库溴铵对异丙酚在不同靶控浓度下脑电双频指数的影响

目的探讨异丙酚在不同靶控浓度下,罗库溴铵对脑电双频指数(Bispectral index,BIS)监测麻醉深度的影响。方法 ASAⅠ级或Ⅱ级择期手术患者60例,随机分为四组:观察组(R2组和R3组)和对照组(C2组和C3组),每组15例。设定异丙酚初始效应室浓度(effect-site concentration,Ce)为4.0 mg·L-1,当患者镇静警觉评分(OAA/S评分)≤1时置入喉罩,机械通气,调节异丙酚靶控浓度,使Ce维持在2.0 mg·L-1或3.0μg·L-1,达到靶浓度后稳定20 min,R2、R3组静脉注射2倍半数有效量(ED95)的罗库溴铵0.6 mg.kg-1,C2、C3组注射生理盐水5 ml。于异丙酚诱导前即刻(T1)、静脉注射罗库溴铵或生理盐水即刻(T2)、TOF消失为0时(T3)、TOF的第一个肌颤搐恢复到5%时(T4)记录BIS值,并记录R2、R3组TOF恢复到T3、T4两个时点所需的时间。结果四组患者性别、年龄、体重之间差异无统计学意义(P0.05);异丙酚在不同靶控浓度下对罗库溴铵的肌松效应的影响无统计学意义(P0.05);T1~T4时C2、C3组BIS值差异无统计学意义(P0.05);与T2时比较,T3、T4时R2组BIS值明显下降(P0.05),但R3、C2和C3组差异无统计学意义(P0.05);R2、C2组与R3、C3组之间比较,差异无统计学意义(P0.05)。结论异丙酚在不同靶控浓度下对罗库溴铵肌松效应无明显影响,但罗库溴铵对BIS值的影响却与镇静深度有关,异丙酚靶控浓度维持在2.0 mg·L-1较浅的镇静状态下,静脉注射2倍ED95剂量的罗库溴铵可引起BIS数值的下降,而在3.0 mg·L-1较深的镇静状态下,2倍ED95剂量的罗库溴铵对BIS值无影响。

Influence of rocuronium on bispectral index during different effect-site concentration of propofol

Aim To investigate whether rocuronium can affect bispcetral index during different effect-site concentration of propofol.Methods Sixty ASA Ⅰ or Ⅱpatients undergoing elective surgery were enrolled in the study,based on Ce of propofol,the patients randomly divided into four groups（R2 and R3）and（C2 and C3）（n=15）.When the Ce of propofol reached 4.0 mg·L-1 and OAA/S score was below one,a laryngeal mask airway was inserted,Ce was then maintained at 2.0 mg·L-1 or 3.0 for 20min.Rocuronium 2ED950.6 mg·kg-1 was given in groups R2 and R3,normal saline（5ml）was given in the other two groups.BIS values were recorded before induction of propofol immediately（T1）,injection of rocuronium or normal saline immediately（T2）,TOF reaching 0（T3）,the first TOF twitch of muscle recovering to 5 %（T4）.The need of time was also recorded when TOF returned to T3 and T4 in groups R2 and R3.Results There was no significant difference in sex,age,body weight among four groups.There was no significant difference in the effect of different effect-site concentration of propofol on muscle relaxation of rocuronium.There was no significant difference in BIS between groups C2 and C3 when T1-T4.The BIS of T3 and T4 were significantly lower than T2 in group R2 but not in group R3,C2 and C3.Compared with the same Ce,there was no significant difference between group R2,C2 and group R3,C3.Conclusion The different effect-site concentration of propofol had no obvious effect on muscle relaxation of rocuronium,but rocuronium altered the BIS scores in moderately sedated patients but not in deeply sedated patients.The scores of BIS were decreased after a bolus 2 times ED95 of rocuronium when Ce of propofol set at 2.0 mg·L-1,but when Ce of propofol set at 3.0 mg·L-1,there were no changes in BIS scores.