全麻诱导期间气管插管时脑电双频谱指数和心率变异性的临床研究

目的 联合应用双频谱指数（BIS）和心率变异性（HRV）监测氟芬合剂、依托咪酯及其加用咪唑安定复合诱导时的麻醉深度，观察诱导后气管插管刺激对BIS和HRV的影响。方法 选择ASAI Ⅱ级，全麻下行择期上腹部手术的患者81例，根据诱导用药是否加用咪唑安定分为咪唑安定（MD ）组和无咪唑安定（MD-）组。观察麻醉诱导前（基础值）、诱导后气管插管前、气管插管即刻、插管后1分钟、3分钟、5分钟时BIS、95%SEF、HRV、BP、HR的变化。结果 诱导给药后两组的SEF、BIS迅速。降低，插管期间MD-组的BIS呈一过性上升，MD 组的BIS无明显变化；而两组的SEF均无明显变化。诱导给药后两组的SBP、DBP、HR及HF均下降，LF及LF/HF比值无明显变化；气管插管后，两组的SBP、DBP和HR均明显上升；LF/HF 比值明显增大。结论 联合应用BIS和HRV监测麻醉深度，可较好地反映全麻病人中枢系统的抑制程度及植物神经系统对伤害刺激的反应性，可更加合理地评价麻醉深度。

Clinical Study of BIS,95%SEF and HRV duringendotracheal intubation after induction of general anesthesia

Objectives　To monitor depth by combination of bispectral index(BIS),95% Spectral edge frequency(SEF) and heart rate variability(HRV) following induction of droperidol-fentanyl,etomidate or co-induction of midazolam at same time and investigate the effect of endotracheal intubation on BIS,95% SEF of electroencephalogram and HRV.Methods　81 ASAⅠ～Ⅱ adult patients,undergoing elective surgery under general anesthesiawere randomly devided into two groups according to whether co-induction of midazolam,i.e.group MD+;group MD-.To view each parameter during pre-induction,post-induction,intubation and 1min,3min,5min after intubation,respectively.Results　Both BIS and 95% SEF were decreased speedly and BP,HR were reduced following induction in two groups.Intubation could increase the lowered BIS in group MD-,but doesn't change the lowered BIS significantly in group MD+.LF/HF of HRV doesn't change after induction in two groups.LF/HF also significantly were increased following BP,HR added during intubation in two groups.Conclusions　Monitoring anesthesia depth by combination of BIS,95% SEF and HRV can strongly predict patients' CNS depression and reaction to noxious stimulation.To value anesthesia depth more applicable.