摘要
目的比较小剂量氯胺酮对脑电熵指数(RE、SE)和脑电双频指数(BIS)的影响。方法22例ASAⅠ或Ⅱ级择期行腹腔镜子宫切除术及卵巢囊肿切除术患者,随机均分为氯胺酮组(K组)和生理盐水组(S组)。麻醉诱导:丙泊酚1～2mg/kg、雷米芬太尼1～1.5μg/kg和维库溴铵0.1～0.15mg/kg,气管插管。麻醉维持:丙泊酚6～8mg.kg-1.h-1、维库溴铵0.1mg.kg-1.h-1和雷米芬太尼7～10μg.kg-1.h-1。在稳定的麻醉和手术状况下,分别单次给予患者氯胺酮0.5mg/kg(K组)或等量的生理盐水(S组),记录给药前(基础值)、给药后5、10、15、20、25和30min七个时点MAP、HR、RE、SE和BIS的数值。结果K组和S组MAP、HR、RE、SE和BIS的基础值差异均无统计学意义。K组RE、SE和BIS在给药后迅速升高,然后逐渐下降,在给药后10min达到峰值,分别比基础值升高了43.8%(P<0.01)、43.2%(P<0.01)和28.8%(P<0.01)。RE和SE增加的幅度显著高于BIS,熵指数和BIS增加持续的时间分别为25min和20min。S组在给药后RE、SE和BIS值与基础值相比差异均无统计学意义。K组和S组在给药前后MAP和HR变化差异无统计学意义。结论在丙泊酚-雷米芬太尼麻醉期间,单次加入小剂量的氯胺酮,熵指数和BIS均不能准确反映其真正的麻醉深度。
Objective To study the effects of low-dose ketamine on entropy indices （RE and SE） and bispectral index （BIS） of the electroencephalogram under propofol-remifentanil anesthesia. Methods Twenty-two ASA class Ⅰ or Ⅱpatients undergoing laparoscopic gynaecological surgery were randomly assigned to ketamine group （group K） and saline group （group S） with 11 cases each. Anesthesia of all patients was induced with propofol 1-2 mg/kg and remifentanil 1-1.5μg/kg, tracheal intubation was facilitated with vecuronium 0.1-0.15 mg/kg and maintained with propofol 6-8 mg · kg^-1 ·h ^-1 , remifentanil 7-10 μg · kg^-1 · h^-1 and vecuronium 0.1 mg ·kg^-1· h^-1. Under stable anaesthetic and surgical conditions, the patients were received either a bolus of ketamine 0.5 mg/kg （group K） or the same volume of normal saline （group S）. Mean arterial blood pressure （MAP）, heart rate （HR）, RE, SE, and BIS were recorded every 5 min until 30 min after ketamine or saline administration. Results There were no significant differences in MAP, HR, RE, SE, and BIS baseline values between the two groups. RE, SE and BIS increased significantly at 5 min after ketamine administration, reached to peak value at 10 min [69.7±9.1 （RE）, 67.5±8.6 （SE） and 60.2± 9.0 （BIS）, respectively]. The maximum increase of RE （43.8%） and SE （43.2%） was higher than that of BIS （28.8%）. The increase of entropy indices and BIS remained statistically significant for 26 rain and 20 rain, respectively. After ketamine administration. RE, SE and BIS did not change significantly in group S. Conclusion Entropy indices just like BIS, can not assess the anaesthetic depth accurately when low-dose ketamine administered as a bolus in patients under propofol- remifentanil anaesthesia.
出处
《临床麻醉学杂志》
CAS
CSCD
2007年第12期983-985,共3页
Journal of Clinical Anesthesiology
关键词
熵指数
双频指数
氯胺酮
全身麻醉
Entropy indices
Bispectral index
Ketamine
General anesthesia
