摘要
目的 探讨全麻维持过程中 ,肌电活动变化对双频谱指数 (BIS)监测准确性的影响。方法 14例ASAⅠ～Ⅱ妇科择期手术患者以异丙酚 (血浆靶浓度 :3 5 μg/ml)、芬太尼 (3μg/kg)、万可松 (0 1mg/kg)行诱导插管 ;之后 ,调整异丙酚血浆靶浓度以维持BIS值在 4 0～6 0之间 ,固定此靶浓度不变。持续监测双频谱指数 (BIS)、肌电图 (EMG)、信号质量指数 (SQI)。在保持异丙酚血浆靶浓度不变的情况下 ,随着肌松作用的减退 ,BIS逐渐升高 ,当满足观察条件 (BIS>70持续 30s以上 ,且EMG >4 0 )时 ,记录此后 5min内的BIS、EMG、SQI、平均动脉压 (MAP)、心率 (HR) ;随后静注追加万可松 0 0 5mg/kg并记录此后 10min内上述参数值。结果 静注万可松 3min后 ,BIS值显著降低 (P <0 0 0 1) ,EMG降低 (P <0 0 5 ) ,SQI升高 (P <0 0 5 ) ;各观察点MAP、HR差异无显著性 (P >0 0 5 )。结论 在麻醉维持过程中 ,肌松作用减退导致的肌电活动增加可引起BIS假性升高 ,从而影响BIS监测的准确性。
Objective To investigate the effect of electromyogram (EMG) variation on bispectral index (BIS) accuracy during the maintenance stage of propofol/fentanyl anesthesia. Methods Fourteen female patients with ASA physical status Ⅰ-Ⅱ, aged 31-64 years, scheduled for elective gynecologic surgical procedures under general anesthesia were enrolled in this study. Anesthesia was induced with propofol (3.5μg/ml), fentanyl (3μg/kg) and vecuronium (0.1mg/kg) iv. and maintained with propofol and fentanyl. For each patient, a specific target-controlled infusion (TCI) was selected to maintain the BIS at between 40 and 60, and it was kept unchanged throughout the study. As EMG rose, the BIS increased gradually. When the parameters met the study requirements (BIS>70, lasting more than 30s and EMG>40), the values of BIS, electromyogram (EMG), signal quality index (SQI), mean arterial pressure(MAP), and heart rate(HR) were recorded every minute for 5min, then additional vecuronium (0.05mg/kg) was administered, and the values of the parameters above mentioned were registered for the next 10min. Results BIS value decreased significantly 3 min after the administration of the additional vecuronium (P<0.001); meanwhile, the EMG lowered (P<0.05) and SQI rose (P<0.05) markedly; the haemodynamic variables remained stable throughout the study (P>0.05). Conclusion A misleading BIS value may be caused by the decline of muscle relaxant during the maintenance stage of propofol/fentanyl anesthesia, which greatly influence the accuracy of BIS monitoring.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2005年第1期43-45,共3页
Medical Journal of Chinese People's Liberation Army
关键词
肌肉松弛剂
麻醉维持
麻醉深度
靶控输注
双频谱指数
肌电图
muscle relaxant
anesthesia maintenance
depth of anesthesia
target-controlled infusion(TCI)
bispectral index(BIS)
electromyogram(EMG)
