摘要
目的 观察不同芬太尼血浆浓度对异丙酚麻醉清醒时血浆浓度及脑电双频指数 (BIS)的影响。方法 选 ASA ～ 级拟在全麻下行择期手术病人 2 8例 ,以异丙酚和芬太尼行麻醉诱导和维持。术毕后 ,每两分观察 1次病人的意识和定向力恢复情况。记录意识和定向力恢复时的 BIS等各指标 ,并抽取血标本测定异丙酚和芬太尼的血浆浓度。根据芬太尼血浆浓度将病人分为 3组 :组 (n= 8) >1.0μg/ L ,组 (n=9) <1.0μg/ L、>0 .45μg/ L ,组 (n=11) <0 .45μg/ L。比较 3组病人清醒和定向力恢复时间、此两时点异丙酚血浆浓度、BIS值等。结果 组 病人意识恢复时血浆异丙酚浓度为 3.2 mg/ L ,高于组 和组 约 5 0 % (P<0 .0 5 ) ,而意识恢复时 3组 BIS值却无显著差异。另外 ,3组病人的平均手术时间、术中单位时间内异丙酚和芬太尼用量、术后清醒时间等 ,均无显著性差异。结论 不同浓度芬太尼可明显影响麻醉清醒所需异丙酚浓度 ,但对清醒时 BIS值却无明显影响 ,提示BIS可独立于药物不同浓度比例 ,反映意识抑制程度的变化。
Objective To investigate the effect of different plasma levels of fentanyl on the concentration of propofol required for patients to regain consciousness and the changes of EEG bispectral index(BIS).Methods Twenty eight patients,aging 20 50years,)scheduled for elective surgery were included in the study.Anesthesia was induced and maintained by intermittent injection of fentanyl and constant infusion of propofol.Propofol infusion was stopped at the end of surgery,and then consciousness and orientation were assessed once per 2 minute.Blood samples for plasma propofol and fentanyl concentrations(PCp and FC p)were taken immediately ,and BIS was recorded when patients regained consciousness and orientation.BIS was also recorded.Patients were divided into three groups depending on FCp at awaking:group Ⅰ with FCp>1μg/L(n=8);group Ⅱ with FCp<1μg/L and>0.45μg/L(n=9);and group Ⅲ with FCp<0.45μg/L(n=11);PCp,BIS,recovery time and other data were compared between three groups.Results Demographic values,the duration of surgery,and consumption of propofol and fentanyl were not different between three groups.The patients in group Ⅲ regained consciousness at significantly higher PCp of 3.2mg/L compared with those in groups Ⅰ and Ⅱ (P<0.05).However,the BIS values at awaking were no difference between three groups.Conclusion The plasma levels of fentanyl affect the concentrations of propofol required for patients to regain consciousness.The BIS values for wakefulness are unaltered at the different concentrations of combinations of propofol and fentanyl.Thus the BIS appears a useful indicator for level of consciousness during emergence from propofol/fentanyl intravenous anesthesia.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
1999年第3期134-136,共3页
Chinese Journal of Anesthesiology
