脑电双频谱指数和正中神经体感诱发电位监测窥喉插管应激反应的比较(1)
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【摘要】 目的 比较脑电双频谱指数和正中神经体感诱发电位监测异丙酚诱导下窥喉插管所致应激反应的可行性和准确性。方法 选择16~40岁ASAⅠ~Ⅲ级无神经精神系流疾病患者15例,异丙酚和司可林麻醉后行气管插管,记录插管前、中、后的MnSSEP、BIS、SBP、DBP、HR。结果 插管即刻MnSSEP的P15N20、N20P25波幅增高,插管后N20P25恢复,P15N20仍增高,其余波幅无改变。插管前后MnSSEP各波潜伏期均无改变,并BIS无明显改变。插管即刻和插管后SBP、DBP较插管前增高而HR无明显改变。结论 正中神经体感诱发电位的N20P25适于反映气管插管对神经系统的影响,P15N20适于反映气管插管对心血管系统的影响,BIS值不能反映窥喉插管的应激反应。
【关键词】窥喉插管;诱发电位;躯体感觉;应激反应; 脑电描记术
Comparison of accuracy of bispectral index and median nerve somatosensory evoked potential for assassment of stress during laryngoscopy and tracheal intubation
YANG Tao,ZHOU Li jun,Ye Xi jiu,et al.Department of Anesthesia,The Second Affiliated Hospital of Sun Yat Sen University,Guangzhou 510120,China
【Abstract】 Objective To comparison of accuracy of bispectral index and median nerve somatosensory evoked potential for assassment of stress during laryngoscopy and tracheal intubation.Methods Fifteen ASA Ⅰ~Ⅱ patients aged 16 40 yrs undergoing elective surgery under general anesthesia.Anesthesia was induced with TCI propofol.After the target effect site concentration of propoful reach 6 μg/ml and maintained for two minutes,intubation was facilitated.Results There were no changes in all latencies of MnSSEP,BIS and HR.During intubation,amplitudes of N20P25 increased,and after that they reinstated.SBP,DBP and P15N20 increased during and after intubation.Conclusion N20P25 is suitable to reflect the effects of intubation to nerve system.P15N20 is suitable to reflect the effects of intubation to cardiovascular system.BIS can not reflect the stress of intubation.
【Key words】Laryngoscopy and Tracheal intubation; Evoked potential; Somatosensory; Stress reaction; Electroencephalography
中山大学中山医学院生理学教研室、疼痛研究中心(周利君 刘勇)
麻醉药的作用是使患者失去神志和记忆并阻断患者对有害刺激的反射,因此理想的麻醉深度监测指标应是能反映上述二者改变的。脑电双频谱指数是最常用的监测麻醉深度的指标之一,大量研究已证明它与镇静状态相关性良好,但它能否监测伤害性刺激引起的应激反应仍有争论。另有研究认为体感诱发电位可监测术中麻醉深度[1],我们也曾报道正中神经体感诱发电位(median nerve somatosensory evoked potential,MnSSEP)与异丙酚血药浓度和患者的神志相关[2],但它能否反映窥喉插管这种伤害刺激对机体的影响目前仍未见报导。因此本研究探讨异丙酚麻醉下窥喉插管(Laryngoscopy and Tracheal Intubation,LTI)对脑电双频谱指数和正中神经体感诱发电位的影响,以寻找适于监测伤害性刺激对机体影响的指标 ......
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