七氟醚与异丙酚麻醉BIS为50时血流动力学参数变化

目的以脑电双频指数（BIS）50±5作为麻醉深度的监测指标,观察3种不同麻醉方法对血流动力学参数变化的影响。方法选择60例择期行上腹部手术的病人,随机分为3组：七氟醚吸入麻醉组（S组）、异丙酚静脉麻醉组（P组）、七氟醚和异丙酚复合麻醉组（C组）。术中维持BIS为50±5,血压和心率波动均不超过基础值的±30%,记录麻醉诱导后到手术探查结束期间不同时点血流动力学参数和BIS值。结果麻醉诱导后3组BIS、收缩压（SBP）和平均动脉压（MAP）均显著下降（F=4.14~19.29,q=8.05~12.31,P〈0.01）,HR在诱导后变化不明显;插管即刻,HR和SBP均上升,且P组、S组上升高于C组,差异有显著性（q=3.09~5.01,P〈0.05）。插管6 min至探查前3组HR、SBP变化差异无显著性（P〉0.05）;探查时,P组、S组HR和SBP上升明显高于C组,差异有显著性（q=3.44~4.67,P〈0.05）。结论维持BIS=50±5时,采用七氟醚和异丙酚（1 mg/L）静吸复合麻醉可使血流动力学参数波动更平稳。

THE EFFECT OF SEVOFLURANE AND PROPOFOL ON HEMODYNAMICS WHEN BIS IS 50

Objective To observe the changes of hemodynamics during three different methods of anesthesia when BIS was 50±5. Methods Sixty ASAⅠorⅡpatients scheduled for upper abdominal surgery under general anesthesia were equally randomized to three groups： group S,anesthesia with sevoflurane;group P,with propofol;group C,with sevoflurane＋TCI propofol（1 mg/L）.BIS was kept at 50±5 at surgery,the fluctuation of heart rate（HR） and systolic blood pressure（SBP） would not exceed 30% of the baseline.Hemodynamic parameters,BIS were recorded at different time points from anesthesia induction till completion of operations research. Results BIS and SBP were significantly decreased after anesthesia induction in three groups,but the changes of HR were not significant.At tracheal intubation,HR and SBP increased in the three groups,which were higher in groups P and S than group C（P0.05）.At exploration,the rising of HR and SBP in groups P and S was more obvious than that in group C（P0.05）. Conclusion When anesthesia with sevoflurane＋TCI propofol（1 mg/L）,maintaining BIS between 50±5,the fluctuation of hemodynamic parameter would be more stable.