老年人腦電雙頻指數、異丙酚血藥濃度與鎮靜深度的相關性_《華西醫學》

作者：

馬友兵 ¹ , 王宏偉 ² ,  林彥俊 ³

1四川省巴中市巴中區城西醫院麻醉科,四川巴中 635500;2鄭州大學第一附屬醫院麻醉科,河南鄭州 450000;3四川大學華西醫院麻醉科,四川成都 610041;

關鍵詞：

老年人異丙酚清醒鎮靜腦電雙頻譜指數

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的:探討老年手術患者椎管內麻醉后應用異丙酚鎮靜,腦電雙頻指數、異丙酚血藥濃度和鎮靜深度之間的相關性［1］。方法:48例ASAⅠ~Ⅱ級擇期手術患者,分為老年組(65~85歲)和年輕組(18~40歲),每組24例。為盡快達到穩態血藥濃度,采用靶控輸注方式給藥。異丙酚靶濃度從0.5 μg/mL起逐漸增加,直至患者對輕推無反應(意識消失),每個濃度維持5min。連續記錄EEG參數,在每一穩態血藥濃度末,記錄BIS、95%SEF, 橈動脈取血(高效液相色譜法測定異丙酚血藥濃度),并評定鎮靜深度(OAA/S評分法)。用Spearman’s等級相關進行相關分析,并計算預測概率 (Pk) 值。結果:兩組BIS (r=0.935~0.955) 與鎮靜水平的相關性優于血藥濃度(r =0.849~0.870)和95%SEF(r =0.503~0.571),BIS的Pk值高(0.942~0.972)。在同一鎮靜評分(OAA/S 4~1)時,老年組BIS值明顯高于年輕組(P lt;0.01),而血藥濃度低于年輕組(P gt;0.05)。結論:BIS在監測異丙酚鎮靜水平及預測意識消失方面有重要價值,在同一鎮靜評分時,老年人BIS值高于年輕人。

引用本文： 馬友兵,王宏偉,林彥俊. 老年人腦電雙頻指數、異丙酚血藥濃度與鎮靜深度的相關性. 華西醫學, 2009, 24(8): 1991-1995. doi: 復制

1.	張德林, 莊小鳳, 裘衛東, 蔣豪, 薛張綱. 腦電雙頻指數對鎮靜深度和血液動力學預測作用的研究[J]. 臨床麻醉學雜志, 2004, (06): 330-332.
2.	OUATTARA A, BOCCARA G, LEMAIRE S, et al. Targetcontrolled infusion of propofol and remifentanil in cardiac anaesthesia: influence of age on predicted effectsite concentrations[J]. Br J Anaesth, 2003, 90(5): 617-22.
3.	GEPTS E. Pharmacokinetic concepts for TCI anaesthesia[J]. Anaesthesia, 1998, 53 Suppl 1: 4-12.
4.	PUNJASAWADWONG Y, BOONJEUNGMONKOL N, PHONGCHIEWBOON A. Bispectral index for improving anaesthetic delivery and postoperative recovery[J]. Cochrane Database Syst Rev, 2007, (4): CD003843.
5.	GLASS P S, BLOOM M, KEARSE L, et al. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers[J]. Anesthesiology, 1997, 86(4): 836-847.
6.	PUNJASAWADWONG Y, BOONJEUNGMONKOL N, PHONGCHIEWBOON A. Bispectral index for improving anaesthetic delivery and postoperative recovery[J]. Cochrane Database Syst Rev, 2007, (4): CD003843.
7.	KAZAMA T, IKEDA K, MORITA K, et al. Comparison of the effectsite k(eO)s of propofol for blood pressure and EEG bispectral index in elderly and younger patients[J]. Anesthesiology, 1999, 90(6): 1517-1527.
8.	MARCIANI R D. Critical systemic and psychosocial considerations in management of trauma in the elderly[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1999, 87(3): 272-280.
9.	SEVERN A. Anaesthesia and the preparation and management of elderly patients undergoing surgery[J]. Eur J Cancer, 2007, 43(15): 2231-2234.
10.	KEARSE LA J R, ROSOW C, ZASLAVSKY A, et al. Bispectral analysis of the electroencephalogram predicts conscious processing of information during propofol sedation and hypnosis[J]. Anesthesiology, 1998, 88(1): 25-34.
11.	BANNISTER C F, BROSIUS K K, SIGL J C, et al. The effect of bispectral index monitoring on anesthetic use and recovery in children anesthetized with sevoflurane in nitrous oxide[J]. Anesth Analg, 2001, 92(4): 877-881.
12.	MONARCH S, WREN K. Geriatric anesthesia implications[J]. J Perianesth Nurs, 2004, 19(6): 379-384.
13.	PAUL S D, O’GARA P T, MAHJOUB Z A, et al. Geriatric patients with acute myocardial infarction: Cardiac risk factor profiles, presentation, thrombolysis, coronary interventions, and prognosis[J]. Am Heart J, 1996, 131(4): 710-715.
14.	AGARWAL A, PANDEY R, DHIRAAJ S, et al. The effect of epidural bupivacaine on induction and maintenance doses of propofol (evaluated by bispectral index) and maintenance doses of fentanyl and vecuronium[J]. Anesth Analg, 2004, 99(6): 1684-1688.

1. 張德林, 莊小鳳, 裘衛東, 蔣豪, 薛張綱. 腦電雙頻指數對鎮靜深度和血液動力學預測作用的研究[J]. 臨床麻醉學雜志, 2004, (06): 330-332.
2. OUATTARA A, BOCCARA G, LEMAIRE S, et al. Targetcontrolled infusion of propofol and remifentanil in cardiac anaesthesia: influence of age on predicted effectsite concentrations[J]. Br J Anaesth, 2003, 90(5): 617-22.
3. GEPTS E. Pharmacokinetic concepts for TCI anaesthesia[J]. Anaesthesia, 1998, 53 Suppl 1: 4-12.
4. PUNJASAWADWONG Y, BOONJEUNGMONKOL N, PHONGCHIEWBOON A. Bispectral index for improving anaesthetic delivery and postoperative recovery[J]. Cochrane Database Syst Rev, 2007, (4): CD003843.
5. GLASS P S, BLOOM M, KEARSE L, et al. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers[J]. Anesthesiology, 1997, 86(4): 836-847.
6. PUNJASAWADWONG Y, BOONJEUNGMONKOL N, PHONGCHIEWBOON A. Bispectral index for improving anaesthetic delivery and postoperative recovery[J]. Cochrane Database Syst Rev, 2007, (4): CD003843.
7. KAZAMA T, IKEDA K, MORITA K, et al. Comparison of the effectsite k(eO)s of propofol for blood pressure and EEG bispectral index in elderly and younger patients[J]. Anesthesiology, 1999, 90(6): 1517-1527.
8. MARCIANI R D. Critical systemic and psychosocial considerations in management of trauma in the elderly[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1999, 87(3): 272-280.
9. SEVERN A. Anaesthesia and the preparation and management of elderly patients undergoing surgery[J]. Eur J Cancer, 2007, 43(15): 2231-2234.
10. KEARSE LA J R, ROSOW C, ZASLAVSKY A, et al. Bispectral analysis of the electroencephalogram predicts conscious processing of information during propofol sedation and hypnosis[J]. Anesthesiology, 1998, 88(1): 25-34.
11. BANNISTER C F, BROSIUS K K, SIGL J C, et al. The effect of bispectral index monitoring on anesthetic use and recovery in children anesthetized with sevoflurane in nitrous oxide[J]. Anesth Analg, 2001, 92(4): 877-881.
12. MONARCH S, WREN K. Geriatric anesthesia implications[J]. J Perianesth Nurs, 2004, 19(6): 379-384.
13. PAUL S D, O’GARA P T, MAHJOUB Z A, et al. Geriatric patients with acute myocardial infarction: Cardiac risk factor profiles, presentation, thrombolysis, coronary interventions, and prognosis[J]. Am Heart J, 1996, 131(4): 710-715.
14. AGARWAL A, PANDEY R, DHIRAAJ S, et al. The effect of epidural bupivacaine on induction and maintenance doses of propofol (evaluated by bispectral index) and maintenance doses of fentanyl and vecuronium[J]. Anesth Analg, 2004, 99(6): 1684-1688.

《華西醫學》

老年人腦電雙頻指數、異丙酚血藥濃度與鎮靜深度的相關性

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

《華西醫學》

老年人腦電雙頻指數、異丙酚血藥濃度與鎮靜深度的相關性

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料