摘要
目的探讨SNAP指数(SI)监测异丙酚-瑞芬太尼麻醉患者镇静深度的可行性。方法 40例择期全麻手术男性患者,ASA Ⅰ或Ⅱ级,年龄18-60岁,体重指数20-30 kg／m2,随机分为R0、 R2、R4、R6组,每组10例。R0组麻醉诱导时靶控输注(TCI)0．9％生理盐水,R2、R4、R6组分别以效应室靶浓度2、4、6 ng／ml TCI瑞芬太尼,输注10 min时开始TCI异丙酚,异丙酚初始效应室靶浓度均为1．5 μg／ml,每4 min增加0．5μg／ml,改良警觉／镇静(OAA／S)评分为1分时给予强直刺激,记录在临床目标 (改良OAA／S评分为1分、睫毛反射消失、对强直刺激反应消失)出现时SI、脑电双频谱指数(BIS)、异丙酚效应室靶浓度(Ct)、异丙酚效应室浓度(Ce),并对SI与改良OAA/S评分、BIS、Ct、Ce进行直线相关分析。结果 SI与改良OAA／S评分、BIS呈正相关,SI与Ct(除外R4组)及Ce(除外R2组)呈负相关; 四组睫毛反射消失时SI差异无统计学意义(P>0．05);与R0组比较,对强直刺激反应消失时其它三组SI升高,Ct及Ce降低(P<0．05)。结论 SI可用于瑞芬太尼-异丙酚麻醉患者镇静深度的监测。
Objective To examine the feasibility of using SNAP index （SI） to measure the depth of sedation during TCI with propofol and remifentanil. Methods Forty consenting ASA Ⅰ or Ⅱ male patients aged 18-64 yrs undergoing elective surgery under general anesthesia were randomly divided into 4 groups （n = 10 each） according to the target effect-site concentration of remifentanil administered by TCI during induction of anesthesia： 0, 2, 4, 6 ng·ml^6. SI （SNAP monitor-Nicolet Biomedical Madison Co U.S.A. ） and BIS （Aspect Medical System U. S. A. ） were used to measure sedation depth. Anesthesia was induced with TCI of remifentanil and propofol. The initial effect-site propofol concentration was 1.5 μg·ml^ - 1 and was increased by 0.5 μg·ml^-1 every 4 min. OAA/S score （5 = alert, 1 = does not respond to prodding）, loss of eyelash reflex （LOR eyelash） and loss of response to electric tetanic stimulation （LOR tetanic） were compared against SI, BIS, Ct （target effect-site propofol concentration） and Ce （calculated effect-site propofol concentration）. Correlation coefficients were calculated between SI and other parameters. Results The 4 groups were comparable with respect to age and body weight. SI well correlated positively with modified OAA/S score and BIS but negatively with Ct and Ce. SI values were higher but Ct and Ce value at LOR tetanic were lower in patient receiving TCI remifentanil as compared with control group. Conclusion SI can be used to measure the depth of sedation produced by TCI of remifentanil and propofol.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2006年第5期394-396,共3页
Chinese Journal of Anesthesiology
关键词
脑电描记术
二异丙酚
哌啶类
清醒镇静
Electroencephalography
Propofol
Pipefidines
Conscious sedation
