丙泊酚联合雷米芬太尼复合麻醉期间右旋美托咪啶对BIS和AAI的影响

目的探讨丙泊酚靶控输注复合雷米芬太尼麻醉期间右旋美托嘧啶(Dex)对脑电双频谱指数(BIS)和听觉诱发电位指数(AAI)的影响。方法将230例行甲状腺全切除术的全麻患者按照随机数字表法均分为研究组和对照组,患者均输注丙泊酚和静脉泵注射雷米芬太尼,研究组给予静脉泵注生理盐水与Dex稀释药物,对照组给予等剂量的生理盐水,观察2组不同麻醉时刻BIS、AAI、MAP及HR的变化情况,同时监测患者生化指标变化。结果 (1)维持麻醉过程中,BIS和AAI值均逐步下降,使用右旋美托嘧啶20min后BIS值显著低于给药前,而AAI值变化不显著;(2)MAP:研究组中与t0时刻相比,t1、t2时刻MAP明显升高(P<0.05),t1、t2时刻MAP高于对照组,t3时刻低于对照组(P<0.05)。(3)HR:研究组中与t0时刻相比,t2、t3时刻HR明显升高(P<0.05);t2、t3时刻HR低于对照组(P<0.05);t0时刻检测显示,AST、ALT、ALB、TP和TBiL等生化指标组间差异无统计学意义,t3时刻研究组AST、ALT、ALB、TP和TBiL与t0时刻相比均降低,且均低于同时刻对照组水平(P<0.05),对照组AST、TBiLt3时刻与t0时刻相比降低(P<0.05)。结论丙泊酚靶控输注复合雷米芬太尼麻醉期间静脉泵注右旋美托嘧啶有助于患者降低BIS而保持AAI不发生明显变化,且麻醉20min维持MAP和HR在正常稳定状态。

Effects of dexmedetomidine on BIS and AAI during propofol combined with remifentanil anesthesia

Objective To investigate the effects of dexmedetomidine (Dex) on bispectral index (BIS) and auditory evoked potential index (AAI) during propofol/remifentanil anesthesia.Methods According to a random table, 230 patients with total thyroidectomy were divided into study group and control group,115 cases each.All of the patients were given intravenous infusion of propofol and remifentanil by injection pumps routinely.The study group were given the infusion of saline and Dex injection intravenously,while the control group received saline alone.The anesthetic BIS,AAI,MAP, HR, and the changes of biochemical index were monitored and observed.Results During the maintenance anesthesia, both BIS and AAI value were gradually declined.After given Dex 20 min, BIS value was significantly lower than before administration,while the AAI value did not change significantly in the study group;MAP:compared with t0, t1,t2 time, MAP increased significantly (P<0.05),t1 t2,MAP times were higher than that of the control group, while t3 was lower than that of the control group (P<0.05).HR:in the study group compared with t0,t2,t3 time HR increased significantly (P<0.05), while t2 t3,and HR times lower than that of the control group (P<0.05);t0, AST,ALT,display time for detection of ALB,TP,TBiL and other biochemical indicators showed no significant difference between the 2 groups,t3 time study group AST,ALT,ALB,TP,TBiL,and t0 were decreased,and at the same time were lower than that of the control group,the difference was statistically significant (P<0.05).In the control group, AST,TBiL t3 and t0 decreased significantly (P<0.05).Conclusion During the anesthesia of propofol target controlled infusion combined with remifentanil, intravenous injection Dex helped patients reducing the BIS and AAI maintenance without significant changes,and the maintenance anesthesia at 20 min, MAP and HR were in a normal steady state.