目的 探討成人七氟醚吸入誘導(dǎo)復(fù)合小劑量乙酰膽堿氣管插管對(duì)腦電雙頻指數(shù)(BIS)和血流動(dòng)力學(xué)的影響。
方法 采用全麻誘導(dǎo)后及氣管插管前后自身對(duì)照的試驗(yàn)方法，選擇ASAI-II級(jí)非困難氣道、擇期手術(shù)病人30例，分別于全麻誘導(dǎo)前 (T1)、誘導(dǎo)后患者入睡時(shí)(T2)及氣管插管前(T3)、插管后1 min(T4)、插管后3 min(T5)時(shí)，監(jiān)測(cè)BIS、心率(HR)及平均動(dòng)脈壓(MAP) 。
結(jié)果 BIS 在T1~T5時(shí)分別為：96.8±1.7、70.4±8.8 、39.2±8.4、43.6±12.9、41.6±9.3, 誘導(dǎo)后各時(shí)點(diǎn)BIS 值均低于誘導(dǎo)前（P lt;0.05）。T3~T5時(shí)的HR均較誘導(dǎo)前升高（P lt;0.05）。MAP在T2和T3時(shí)與T1比降低，T4時(shí)比T1升高（P lt;0.05）；但在T5時(shí)回到誘導(dǎo)前水平（P gt;0.05）。T4時(shí)的BIS值、MAP和HR值均顯著高于T3時(shí)（P lt;0.05）。術(shù)后隨訪無(wú)1例病人對(duì)誘導(dǎo)插管過(guò)程有記憶。
結(jié)論 七氟醚復(fù)合小劑量乙酰膽堿誘導(dǎo)插管，可提供較好的鎮(zhèn)靜和(或) 麻醉深度，但尚不能很好地消除氣管插管引起的不良應(yīng)激反應(yīng)。
引用本文： 黃偉,王健,羅林麗,周軍. 七氟醚吸入誘導(dǎo)插管期間腦電雙頻指數(shù)和血流動(dòng)力學(xué)的變化. 中國(guó)循證醫(yī)學(xué)雜志, 2007, 07(12): 869-872. doi: 復(fù)制
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| 2. | Ekman A, Lindholm ML, Lennmarken C, et al. Reduction in the incidence of awareness using BIS monitoring.Acta Anaesthesiol Scand, 2004, 48(1): 20-26. |
| 3. | Myles PS, Leslie K, Forbes A, et al. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomized controlled trial. Lancet, 2004,363 (9423): 1757-1763. |
| 4. | Guignard B, Menigaux C,Dupont X,et al.The effect of remifentanil on the bispectral index change and hemodynamic responses after orotracheal intubation. Anesth Analg, 2000, 90(1): 161-167. |
| 5. | Patel SS,Goa KL. Sevoflurane:A review of its pharmacodynamics and pharmacokinetic properties and its clinical use in general anaesthesia.Drugs,1996,51(4): 658-700. |
| 6. | Edwards ND, Alford AM,Dobson PM, et al. Myocardial ischaemia during tracheal intubation and extubation. Br J Anaesth,1994, 73(4) : 537-539. |
| 7. | Guignard B,Chauvin M. Bispectral index increases and decreases are not always signs of inadequate anesthesia. Anesthesiology, 2000,2(3): 903-905. |
| 8. | El-Orbany MI, Joseph NJ, Salem MR, et al. The neuromuscular effects and tracheal intubation conditions after small doses of succinylcholine. Anesth Analg, 2004,98(6): 1680-1685. |
| 9. | Kopman AF,Zhaku B,Lai KS. The “intubating dose” of succinylcholine: the effect of decreasing doses on recovery time.Anesthesiology, 2003,99(5): 1050-1043. |
- 1. Muzi M, Robinson BJ, Ebert TJ,et al. Induction of anesthesia and tracheal intubation with sevoflurane in adults. Anesthesiology, 1996,85(3): 536-543.
- 2. Ekman A, Lindholm ML, Lennmarken C, et al. Reduction in the incidence of awareness using BIS monitoring.Acta Anaesthesiol Scand, 2004, 48(1): 20-26.
- 3. Myles PS, Leslie K, Forbes A, et al. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomized controlled trial. Lancet, 2004,363 (9423): 1757-1763.
- 4. Guignard B, Menigaux C,Dupont X,et al.The effect of remifentanil on the bispectral index change and hemodynamic responses after orotracheal intubation. Anesth Analg, 2000, 90(1): 161-167.
- 5. Patel SS,Goa KL. Sevoflurane:A review of its pharmacodynamics and pharmacokinetic properties and its clinical use in general anaesthesia.Drugs,1996,51(4): 658-700.
- 6. Edwards ND, Alford AM,Dobson PM, et al. Myocardial ischaemia during tracheal intubation and extubation. Br J Anaesth,1994, 73(4) : 537-539.
- 7. Guignard B,Chauvin M. Bispectral index increases and decreases are not always signs of inadequate anesthesia. Anesthesiology, 2000,2(3): 903-905.
- 8. El-Orbany MI, Joseph NJ, Salem MR, et al. The neuromuscular effects and tracheal intubation conditions after small doses of succinylcholine. Anesth Analg, 2004,98(6): 1680-1685.
- 9. Kopman AF,Zhaku B,Lai KS. The “intubating dose” of succinylcholine: the effect of decreasing doses on recovery time.Anesthesiology, 2003,99(5): 1050-1043.