摘要
目的 应用脑电双频指数 (BIS)等指标 ,观察语言命令反应消失 (意识消失 )与睫毛反射消失所需麻醉水平 ,并探讨异丙酚与芬太尼在此过程的相互作用。方法 44例病人随机分为两组 :P组和 PF组。诱导 :静注芬太尼 2μg/ kg(PF组 )或生理盐水 (P组 ) ,5分后 ,以 30 mg· kg- 1 · h- 1 的速率推注异丙酚。记录意识消失和睫毛反射消失时各脑电参数、消失时间和异丙酚用量。结果 单用异丙酚睫毛反射消失时 BIS值低于意识消失时的数值 (P<0 .0 1)。辅用芬太尼 ,意识和睫毛反射消失时的各脑电参数中 ,仅有 BIS值与基础值比较呈有统计学意义的降低 (P<0 .0 1)。 PF组病人意识消失时间和异丙酚用量均较 P组减少 (P <0 .0 5 ) ,意识消失时的 BIS值也高于 P组 (P<0 .0 5 ) ,但两组间SEF和 MF值无显著差异。另外 ,PF组的两时点间各指标 (包括 BIS)比较 ,未见统计学差异。结论 芬太尼可明显地加强异丙酚对意识的抑制作用 ,同时也使意识消失时的 BIS值发生变化 ;睫毛反射消失与意识 (语言命令反应 )消失是否代表同一麻醉水平 ,与所用药物组合或方法有关 ;BIS在反映中枢抑制水平变化方面优于 SEF和 MF。
Objective To compare propofol requirements and the changes of the EEG parameters:bispectral index(BIS),spectral edge frequency(SEE)and median frequency(MF)when unconsciousness and loss of eyelash reflex were produced by propofol alone or propofol plus fentanyl.Methods Forty four patients scheduled for elective surgical procedures were allocated into 2 groups(group P and group PF).Fentanyl 2 μg/kg in group PF (n=22) or normal saline in group P(n=22) was administered intravenously.Five min later,all patients were induced with propofol at a constant rate infusion 30 mg -1 ·kg -1 ·h -1 using a syringe pump.Immediately following infusion of propofol consciousness and eyelash reflex were assessed once per 30s.EEG parameters,propofol doses and taken time were recorded at endpoints of unconsciousness and loss of eyelash reflex.Results Propofol plus fentanyl 2 μg/kg,produced unconsciousness and loss of eyelash reflex with shorter time and less doses and higher BIS values compared with those in group P.SEF and MF failed to show differences between two groups at each endpoint.Among all recorded parameters,only BIS in group P showed a significant difference between unconsciousness and loss of eyelash reflex,which was lower at the latter endpoint(P<0 01).Conclusion Fentanyl effectively enhances effect of unconsciousness and loss of eyelash reflex produced by propofol;with fentanyl,propofol produces unconsciousness and loss of eyelash reflex at higher BIS level compared with propofol alone;Unconsciousness and loss of eyelash reflex occur at the similar anesthetic levels with propofol/fentanyl,but using propofol alone,abolition of eyelash reflex requires a slightly deeper anesthetic level indicated by lower BIS values than abolition of response to verbal commands,suggesting that loss response to verbal commands and loss of eyelash reflex do not always represent the same anesthetic level.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
1999年第2期96-98,共3页
Chinese Journal of Anesthesiology
