CAJ | 학술논문

目的探讨不同速度输注异丙酚静脉麻醉下低温体外循环期间大脑状态指数(cerebral state index,CSI)及爆发抑制比(burst supression ratio,BS%)的变化.方法择期行低温体外循环下心脏瓣膜置换手术患者44例,年龄(18～60)岁.随机分为两组,每组22例.麻醉诱导采用静脉注射异丙酚1mg/ks～1.5 mg/kg,芬太尼10μg/kg,维库溴铵0.1 mg/kg.麻醉维持采用持续静脉输注异丙酚4 mg·kg-1·h-1(P4组)或6 rag·kg-1·h-1(P6组),芬太尼5gμ·kg-·1h-1.记录体外循环(cardio pulmonany bypass,CPB)前5 min(T0)、CPB后2 min(T1)、CP8开始后30 min(T2)、CPB开始后60 min(T3)、停CPB后15 min(T4)时的CSI、BS%、鼻咽温度、平均动脉压(MAP)、心率(HR).结果 CPB期间两组的CSI均下降,与体外循环前比较差异有统计学意义(P<0.05或0.01),P6组CPB 30 min、60 min的CSI与P4组比较为差异有统计学意义(P<0.01).P6组在CPB 30 rain、60 min时出现爆发抑制比,与CPB前比较为差异有统计学意义(P<0.01),与P4组比较为差异有统计学意义(P<0.01).结论低温CPB期间持续输注异丙酚6 mg·kg-1·h-1时,CSI处于较低水平,BS%明显增多,应适当减少异丙酚的输注速度,以维持合适的麻醉深度.
목적 탐토불동속도수주이병분정맥마취하저온체외순배기간대뇌상태지수(cerebral state index,CSI)급폭발억제비(burst supression ratio,BS%)적변화.방법 택기행저온체외순배하심장판막치환수술환자44례,년령(18～60)세.수궤분위량조,매조22례.마취유도채용정맥주사이병분1mg/ks～1.5 mg/kg,분태니10μg/kg,유고추안0.1 mg/kg.마취유지채용지속정맥수주이병분4 mg·kg-1·h-1(P4조)혹6 rag·kg-1·h-1(P6조),분태니5gμ·kg-·1h-1.기록체외순배(cardio pulmonany bypass,CPB)전5 min(T0)、CPB후2 min(T1)、CP8개시후30 min(T2)、CPB개시후60 min(T3)、정CPB후15 min(T4)시적CSI、BS%、비인온도、평균동맥압(MAP)、심솔(HR).결과 CPB기간량조적CSI균하강,여체외순배전비교차이유통계학의의(P<0.05혹0.01),P6조CPB 30 min、60 min적CSI여P4조비교위차이유통계학의의(P<0.01).P6조재CPB 30 rain、60 min시출현폭발억제비,여CPB전비교위차이유통계학의의(P<0.01),여P4조비교위차이유통계학의의(P<0.01).결론 저온CPB기간지속수주이병분6 mg·kg-1·h-1시,CSI처우교저수평,BS%명현증다,응괄당감소이병분적수주속도,이유지합괄적마취심도.
Objective To investigate the changes of the cerebral state index (CSI) and burst suppression ratio ( BS% ) with different infusion speed of propofol during hypothermic cardiopulmonary bypass. Methods Forty-four patients aged 18-60 years undergoing elective cardiac valve replacement under hypothermic CPB were enrolled in this study. The CSI and BS% were used to measure sedation depth. Anesthesia was induced with fentanyl 10 μg/kg and propofol 1.0 mg/kg-1. 5 mg/kg. Tracheal intubation was facilitated with vecuronium 0.1 mg/kg and controlled ventilation was performed. Anesthesia was maintained with intravenous propofol infusion at ronium bolus. CSI, BS%, nasopharyngeal temperature, MAP and HR were measured and recorded at 5 rain before CPB, 2 min, 30win, 60 rain of CPB, and 15 rain after the end of CPB. Results The CSI and temperature generally declined during CPB (P <0.05or 0. 01 ), and returned to pre-CPB values after separation from CPB in the two groups. The CSI and BS% were significantly lower in group P6 than that in group P4 at 30 and 60 rain of CPB (P <0. 01 ). Conclusion The CSI was lower and the BS% was higher with speed was necessary to maintain a suitable anesthesia depth.