芬太尼对听觉诱发电位指数、双频谱指数及气管插管反应的影响

Impacts of fentanyl on A-line ARX index,bispectral index,and hemodynamic response induced by tracheal intubation

  • 摘要: 目的: 探讨异丙酚-芬太尼诱导过程中,以听觉诱发电位指数(AAI)为镇静"基准",推荐剂量的芬太尼对AAI、双频谱指数(B IS)、心血管及体动反应的影响。方法: 34例ASAⅠ择期手术患者随机均分为两组: 异丙酚组(P组)和异丙酚/芬太尼组(PF组)。PF组静注4μg/kg芬太尼,P组静注等容量生理盐水,2m in后泵注异丙酚(30mg.kg-1.h-1),患者入睡后,用压力袖带隔离一侧前臂,静注维库溴铵0.1mg/kg。当AAI值达到15±5后调整异丙酚注速以维持此AAI值5m in后行气管插管。记录进喉镜1m in内隔离侧手臂运动情况;记录诱导前、进喉镜前及插管后1m in、2m in、5m in患者收缩压(SAP)、舒张压(DAP)、心率(HR)、B IS、AAI值。结果: 两组患者B IS值在插管前、后组内及组间的差异均无显著性(P>0.05);PF组AAI在插管前、后的差异无显著性,而P组AAI在插管后1m in明显高于进喉镜前及PF组(P<0.05),之后迅速下降至进喉镜前水平;插管刺激引起的循环波动及体动反应P组明显大于PF组(P<0<0.01)。结论: 在AAI为 15±5镇静水平上,芬太尼 (4μg/kg)不影响 BIS对插管刺激的反应;可抑制插管后 AAI的一过性增高;可明显减少插管体动反应及插管后循环波动,但在插管前易引起低血压和心动过缓。

     

    Abstract: Objective: To investigate the effects of fentanyl on A-line ARX Index(AAI);bispectral index(BIS) and hemodynamic response induced by orotracheal intubation,using the AAI as sedation "baseline".Methods: Thirty four ASA Ⅰ-Ⅱ(female) patients were equally randomized to receive either propofol infusion(30mg·kg-1·h-1) 2min preceded by 4μg/kg(fentanyl)(group PF) or preceded by comparable volume of normal saline(group P).After loss of consciousness,and before(administration) of vecuronium 0.1mg/kg,a tourniquet was applied to one arm and inflated to 20kPa above systolic pressure.The trachea was intubated 5min after maintenance of AAI within 15 5.Gross movement within the 1st minute after orotracheal(intubation) was recorded;BIS,AAI and hemodynamic parameters including systolic arterial pressure(SAP),diastolic arterial pressure(DAP) and heart rate(HR) were measured invasively pre-induction,before laryngoscopy,and 1,2,5min after (tracheal) intubation.(Results: Neither) within nor intergroup differences were found in BIS before or after intubation(P>0.05).AAI in group P increased significantly only at 1min after tracheal intubation(P<0.05,vs pre-larngoscopy or group PF),and decreased to pre-laryngoscopy level rapidly.The tracheal intubation caused a greater haemodynamic increase and higher incidence of movement in group P than those in group PF(P<0.01).Conclusion: At the sedation level of AAI at 15±5,fentanyl 4μg/kg attenuates haemodynamic reactions and prevents body movement induced by laryngoscopy and intubation.It also inhibits transient AAI increase after intubation.However,it has no significant effect on BIS.fentanyl;anesthesia,general;evoked potential,auditory

     

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