不同剂量舒芬太尼对听觉诱发电位指数及血流动力学的影响

目的观察不同剂量舒芬太尼全麻诱导时听觉诱发电位指数及血流动力学的变化,探讨听觉诱发电位是否能反映舒芬太尼的镇静水平以及适合于麻醉诱导的舒芬太尼剂量。方法入选全麻下行手术治疗的90例25～45岁患者,采用双盲、对照原则将纳入标准的患者随机分为三组（n=30）;静脉丙泊酚血浆靶浓度为3μg/mL,行警觉-镇静评估法（OAA/S）评分。待OAA/S评分达到3分时静脉给予舒芬太尼：A组剂量为0.2μg/kg,B组剂量为0.3μg/kg,C组剂量为0.35μg/mL,观察加入舒芬太尼后第1、2、3分钟三组的听觉诱发电位指数（AAI）值和血流动力学变化。结果当异丙酚靶控在3μg/mL达OAA/S评分3分时,与T0相比,三组在T1、T2、T3时的AAI值均降低,有显著性差异（P〈0.01）,C组在T1、T2、T3时AAI值低于A组和B组（P〈0.01）,B组在T1、T3时AAI值低于A组（P〈0.01）。三组血流动力学均保持在正常范围内;C组HR1、HR2、HR3数值偏低（最低心率56次/min）。结论听觉诱发电位能反映舒芬太尼的镇静水平,当异丙酚靶控在3μg/mL,0.3μg/mL剂量的舒芬太尼在麻醉诱导时是安全合适的。

Effects of different doses of Sufentanil on auditory evoked potential index and hemodynamics

Objective To investigate the effects of different doses of sufentanil on auditory evoked potential index(AAI) and hemodynamics in patients during anesthesia induction and the appropriate dose of sufentanil.Methods Ninety adult patients of American Society of Anesthesiologists physical status ⅠorⅡ(ASAⅠorⅡ),aged 25-45 years,were included in this study.They were randomly divided into 3 groups with 30 cases each,according to the different induction doses of sufentanilP: sufentanil 0.2 μg/mL group(group A),sufentanil 0.3 μg/mL group(group B),sufentanil 0.35 μg/mL group(group C).All patients were induced with TCI of propofol(target plasma concentration set at 3.0 μg/mL) and IV of sufentanil.At the time of propofol achieving the target plasma concentration of 3.0 μg/mL,Observer′s assessment of alertness/sedation(OAA/S) was measured.When OAA/S reached 3 scores,sufentanil was administrated with IV of 0.2,0.3,0.35 μg/kg.Systolic pressure(SP),diastolic pressure(DP),mean arterial pressure(MAP),heart rate(HR),oxygen saturation of pulse oximeter(SpO2) and auditory evoked potential index(AAI) were recorded at immediately(T0),l time(T1),2 time(T2) and 3 min(T3) after injection of sufentanil using Intellivue MP50 monitor and EEG monitoring device.Results The valus of AAI at T1-3 were significantly lower than that at T0 in three groups.The valus of AAI at T1-3 in group C were significantly lower than those in group B and group A;The valus of AAI at T1,T3 in group B were significantly lower than those in group A.There were no significant differences in the hemodynamics during anesthesia induction between 3 groups.The valus of HR at T1-3 in group C is low(the lowest heart rate was 56 times/minute).Conclusion AAI can monitor the levels of sedation induced with sufentanil when combined with propofol TCI with Cp set at 3.0 μg/mL.Sufentanil 0.3 μg/kg(group B) is the suitable dose of choice for anesthesia induction when combined with propofol TCI with Cp set at 3.0 μg/mL in patients and hemodynamics is stable.