尼卡地平对丙泊酚靶控输注麻醉时BIS值的影响
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摘要
目的 研究以不同剂量尼卡地平用于丙泊酚靶控麻醉病人,观察尼卡地平对脑电双频指数(BIS)的影响。方法60例ASAⅠ～Ⅱ级择期腹部手术病人,随机分为四组,单纯丙泊酚组(P组)、尼卡地平Ⅰ组(N1组)、尼卡地平Ⅱ组(N2组)和尼卡地平Ⅲ组(N3组),每组15例:诱导时芬太尼3ug·kg~(-1),维库溴铵0.12mg·kg~(-1),靶控输注异丙酚气管插管后调节丙泊酚靶浓度,使脑电双频指数稳定在45～55,分别静注生理盐水5ml、尼卡地平3ug·kg~(-1)、6ug·kg~(-1)、9ug·kg~(-1)。分别于入室后(T0)、注药前(T1)和注药后1、3、5、10分钟(T2、T3、T4、T5)记录丙泊酚效应室浓度、HR、动脉血压和BIS值。结果 静脉注射尼卡地平后,平均动脉压下降,下降的幅度与尼卡地平的剂量正相关,血压降低持续的时间与尼卡地平的剂量也有关,剂量越大,时间越长;血压降低的同时,心率增加,增加的幅度和时间与尼卡地平所用剂量正相关;使用尼卡地平后,BIS值没有明显变化。结论 单次静脉注射尼卡地平可以引起异丙酚麻醉病人血压降低,心率增快,但不影响BIS值。丙泊酚靶控麻醉下应用小剂量尼卡地平时,BIS仍是监测静脉麻醉深度的可靠指标。
Object To investigate the effects of nicardiping on bispectral index in patients during anesthesia with target-controlled infusion(TCI) of propofol. Methods Sixty ASA I - II patients aged between 22-60 yr and weighing 48-95 kg undergoing Laparoscopic cholecystectomy , were randomly allocated to one of four groups with 15 patients in each group: In propofol group(group P) anaesthesia was induced and maintained with propofol TCI;In nicardiping group I (group Nl), II (group N2) and 1 (group N3),anaesthesia was induced and maintained with propofol given by TCI and adjust target set to maintained bispectral index(BIS) with 45~55,given nicardiping 3ug ? kg~(-1) > 6ug ? kg~(-1), 9ug?kg~(-1). All the patients anaesthesia were induced with fentanyl 3ug ? kg~(-1), vecuronium0.12mg ? kg~(-1).Target consentration of propofol ,BIS,MAP and HR were measured invasively pre-inductio(T0), pre-treatment(nicardiping or saline Tl),and at 1, 3, 5,10 min after treatment(T2,T3,T4,T5). Result (1)After nicardipine was intravenously injected,the value of the MAP decreased.Both the degree and the duration of this affection were positively correlation with the dosage of the nicardipine given: the higher the dosage.the longer the duration when the value of blood pressure decreased.(2)Heart rate increased while the blood pressure declining.Both the degree and duration of this increasing were positively correlation with the dosage of the nicardipine administrated.(3)The usage of ncardipine have no significant effect on the value of BIS. Conclusion Low-does nicardipine do not alter the bispectral index during anaesthesia with propofol.
Object To investigate the effects of nicardiping on bispectral index in patients during anesthesia with target-controlled infusion(TCI) of propofol. Methods Sixty ASA I - II patients aged between 22-60 yr and weighing 48-95 kg undergoing Laparoscopic cholecystectomy , were randomly allocated to one of four groups with 15 patients in each group: In propofol group(group P) anaesthesia was induced and maintained with propofol TCI;In nicardiping group I (group Nl), II (group N2) and 1 (group N3),anaesthesia was induced and maintained with propofol given by TCI and adjust target set to maintained bispectral index(BIS) with 45~55,given nicardiping 3ug ? kg~(-1) > 6ug ? kg~(-1), 9ug?kg~(-1). All the patients anaesthesia were induced with fentanyl 3ug ? kg~(-1), vecuronium0.12mg ? kg~(-1).Target consentration of propofol ,BIS,MAP and HR were measured invasively pre-inductio(T0), pre-treatment(nicardiping or saline Tl),and at 1, 3, 5,10 min after treatment(T2,T3,T4,T5). Result (1)After nicardipine was intravenously injected,the value of the MAP decreased.Both the degree and the duration of this affection were positively correlation with the dosage of the nicardipine given: the higher the dosage.the longer the duration when the value of blood pressure decreased.(2)Heart rate increased while the blood pressure declining.Both the degree and duration of this increasing were positively correlation with the dosage of the nicardipine administrated.(3)The usage of ncardipine have no significant effect on the value of BIS. Conclusion Low-does nicardipine do not alter the bispectral index during anaesthesia with propofol.
引文
[1] 植松大辅,福内靖男.脑循环Ca拮抗剂.脑神经,1990;42:17
[2] 汪海.史大军.路新强等,新型钙通道拮抗剂尼卡地平衍生物的心血管效应.军事医学科学院院刊.1997,01:8-10
[3] Nishiyama T, Matsukawa T, Hanaoka K. Interactions between nicardipine and enflurane, isoflurane, and sevoflurane. Can J Anaesth. 1997 Oct;44(10): 1071-6
[4] Saitoh Y, Narumi Y, Fujii Y. Post-tetanic count and train-of-four responses during neuromuscular block produced by vecuronium and infusion of nicardipine. Br J Anaesth. 1999 Aug;83(2):340-2.
[5] 穆娅玲,李军,张宏.尼卡地平对维库溴铵和阿曲库铵肌松时效的影响.中华麻醉学杂志,2000;20:341-344.
[6] Hirota K, Kabara S, Kushikata T, et al. Effects of nicardipine and diltiazem on the bispectral index and 95% spectral edge frequency. Eur J Anaesthesiol. 2003 Oct;20(10):809-12
[7] 李云辉,仇海燕.钙拮抗剂与脑循环.中国冶金工业医学杂志.1997,14(2):100-103
[8] 庄心良,曾因明,陈伯銮.现代麻醉学.第3版.北京:人民卫生出版社,2003
[9] Vuyk J, Mertens MJ: Bispectral index scale (BIS) monitoring and intravenous anaesthesia. Adv Exp Med Biol, 2002. 523:95-104
[10] Drummond JC: Monitoring depth of anesthesia: With emphasis on the application of the bispectral index and the middle latency auditory evoked response to the prevention of recall. Anesthesiology, 2000. 93:876-882
[11] Absalom AR, Sutcliffe N, Kenny GN: Closed-loop control of anesthesia using bispectral index. Anesthesiology, 2002. 96:67-73
[12] M Kluger. The Bispectral Index during an anaphylactic circulatory arrest. Anaesthesia and Intensive Care, 2001. 29:544-547
[13] Glass PS, Bloom M, Kearse L, et al.. Bispectral analysis measures sedadon and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology, 1997. 86: 836-847
[14] 黄震华,徐济民.新型钙通道拮抗剂尼卡地平.国外医药?合成药生化药制剂分册,1995,16(2):91-93.
[15] Clifton GG, Gook ME, Bienvenu GS, et al. Intravenous nicardipine in severe system ic hypertension. Am J cardiol, 1989, 64:16-18.
[16] Cheung AT, Guvakov DV, Weiss SJ, et al. Nicardipine intravenous bolus dosing for acutely decreasing arterial blood pressure during general anesthesia for cardiac operations: pharmacokinetics, pharmacodynamics, and associated effects on left ventricular function.Anesth Analg. 1999 Nov;89(5): 1116-23
[17]Charles R,Lambert MD.Penpine CJ.Effecs of intravenous and intracoronary nicardipine.Am J Cardiol.1989,64(15):8-15
[2] 汪海.史大军.路新强等,新型钙通道拮抗剂尼卡地平衍生物的心血管效应.军事医学科学院院刊.1997,01:8-10
[3] Nishiyama T, Matsukawa T, Hanaoka K. Interactions between nicardipine and enflurane, isoflurane, and sevoflurane. Can J Anaesth. 1997 Oct;44(10): 1071-6
[4] Saitoh Y, Narumi Y, Fujii Y. Post-tetanic count and train-of-four responses during neuromuscular block produced by vecuronium and infusion of nicardipine. Br J Anaesth. 1999 Aug;83(2):340-2.
[5] 穆娅玲,李军,张宏.尼卡地平对维库溴铵和阿曲库铵肌松时效的影响.中华麻醉学杂志,2000;20:341-344.
[6] Hirota K, Kabara S, Kushikata T, et al. Effects of nicardipine and diltiazem on the bispectral index and 95% spectral edge frequency. Eur J Anaesthesiol. 2003 Oct;20(10):809-12
[7] 李云辉,仇海燕.钙拮抗剂与脑循环.中国冶金工业医学杂志.1997,14(2):100-103
[8] 庄心良,曾因明,陈伯銮.现代麻醉学.第3版.北京:人民卫生出版社,2003
[9] Vuyk J, Mertens MJ: Bispectral index scale (BIS) monitoring and intravenous anaesthesia. Adv Exp Med Biol, 2002. 523:95-104
[10] Drummond JC: Monitoring depth of anesthesia: With emphasis on the application of the bispectral index and the middle latency auditory evoked response to the prevention of recall. Anesthesiology, 2000. 93:876-882
[11] Absalom AR, Sutcliffe N, Kenny GN: Closed-loop control of anesthesia using bispectral index. Anesthesiology, 2002. 96:67-73
[12] M Kluger. The Bispectral Index during an anaphylactic circulatory arrest. Anaesthesia and Intensive Care, 2001. 29:544-547
[13] Glass PS, Bloom M, Kearse L, et al.. Bispectral analysis measures sedadon and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology, 1997. 86: 836-847
[14] 黄震华,徐济民.新型钙通道拮抗剂尼卡地平.国外医药?合成药生化药制剂分册,1995,16(2):91-93.
[15] Clifton GG, Gook ME, Bienvenu GS, et al. Intravenous nicardipine in severe system ic hypertension. Am J cardiol, 1989, 64:16-18.
[16] Cheung AT, Guvakov DV, Weiss SJ, et al. Nicardipine intravenous bolus dosing for acutely decreasing arterial blood pressure during general anesthesia for cardiac operations: pharmacokinetics, pharmacodynamics, and associated effects on left ventricular function.Anesth Analg. 1999 Nov;89(5): 1116-23
[17]Charles R,Lambert MD.Penpine CJ.Effecs of intravenous and intracoronary nicardipine.Am J Cardiol.1989,64(15):8-15