摘要
目的比较脑电双频指数(BIS)指导老年高血压患者腹部手术七氟醚和异丙酚复合麻醉维持效果。方法择期拟行腹部手术老年患者50例,ASAⅡ～Ⅲ级,年龄65～80岁,既往有高血压病史。随机分为2组(n=25):七氟醚麻醉组(S组)和异丙酚麻醉组(P组)。麻醉诱导给予舒芬太尼初始效应室靶浓度0.25ng/ml,异丙酚初始血浆靶浓度1.5μg/ml并逐渐增加浓度,患者意识消失后静脉注射罗库溴铵0.6mg/kg,气管插管后行机械通气。麻醉维持时S组吸入七氟醚,P组靶控输注异丙酚,两组均靶控输注舒芬太尼,效应室靶浓度为0.15ng/ml,静脉输注罗库溴铵0.15mg(kg·h)维持BIS在40～60,平均动脉压、心率波动不超过基础值的30%。观察术中HR、MAP、BIS、两组血管活性药物使用情况。结果与P组比较,S组手术开始后即刻BIS值高(P<0.05);S组术中血管活性药物使用总例数明显低于P组,麻黄碱使用次数低于P组(P<0.05)。结论 BIS更适合指导老年高血压患者腹部手术复合七氟醚维持麻醉。
Objective To compare effects between sevoflurane-maintaining and propofol-maintaining anesthesia guided by Bispectral index in elderly hypertensive patients undergoing abdominal surgery. Methods Fifty ASA class II or III patients aged 65 - 80 yr with a past medical history of hypertension undergoing general anesthesia for elec- tive intra-abdominal surgery were assigned randomly to one of two groups （n =25 each） ： sevoflurane group （group S） and propofol group （group P）. Anesthesia was induced with TCI of propofol and sufentanil. The initial target effect-site concentration （Ce） of sufentanil was set at 0.25ng/m1 and initial target plasma concentration （Cp）of propofol set at 1.5 ug/ml, and then increased until loss of consciousness. Tracheal intubation was facilitated with rocuronium 0. 6 mg/kg and mechanically ventrilation was started. Anesthesia was maintained with inhalation of sevoflurane in group S, TCI of propofol in group P, and sufentanil by TCI （ Ce 0.15ng/ml） and intravenous rocuronium 0.15mg/（kg · h） in both groups. BIS was maintained at 40 - 60, and changes of MAP and HR were less than 30% of the baseline in both groups. Vasoactive drugs were adjusted according to haemodynamic responses to surgical stimuli . Results BIS was significantly higher in group S than in group P after incision. The cases of vaso- active drugs use and ephedrine use were more in group P than in group S during anesthetic maintenance （ P 〈 0.05 ）. Conclusion Bispectral index monitor provides better hemodynamics under sevoflurane-maintaining anesthesia in elderly hypertensive patients undergoing abdominal surgery .
出处
《中国医刊》
CAS
2012年第5期39-41,共3页
Chinese Journal of Medicine
关键词
高血压
麻醉
药物
脑电双频指数
Hypertensive patients
Anesthesia
Drug
Bispectral index
