体外循环心脏手术术中影响听觉诱发电位相关因素分析.doc

文档介绍：体外循环心脏手术术中影响听觉诱发电位
相关因素分析
230001,安徽省立医院麻醉科
马骏方才王瑞明康芳王瑞婷
摘要
目的:听觉诱发电位(AEP)应用于体外循环心脏手术病人,探讨体外循环(CPB)中可能影响AEP的因素。方法:择期心脏瓣膜置换术患者20例,咪唑安定、乙咪酯、芬太尼、罗库溴铵诱导气管插管,靶控输注(TCI)丙泊酚、瑞芬太尼维持麻醉,设立麻醉与体外循环前后14个观察点,采用自身对照观察AEP变化和CPB时灌注流量(AQ)、灌注压(PP)、中心静脉压(CVP)、鼻咽温(Temp1)、直肠温(Temp2)对AEP的影响。术后访视病人。结果:麻醉诱导后AEP迅速下降(P<),切皮、锯胸骨、主动脉插管及转机前AEP升高(P<)。CPB期间,AEP降低并与心脏停搏鼻温最低时达谷值(P<)。恢复循环后AEP值上升,停机时恢复CPB前水平(P<)。无术中知晓发生。结论:AEP能及时准确的反映体外手术各时期的麻醉镇静深度变化,有效预防术中知晓。CPB期间,低温、低灌注压对AEP抑制明显。
关键词:听觉诱发电位指数;体外循环;低温;
The effect of open cardiac surgery around cardiopulmonary bypass on auditory evoked potential
Ma Jun ,Wang Ruiming,Kang Fang ,Wang Ruiting
Abstract: Objective Auditory evoked potential (AEP) monitors patients in heart valve replacement undergoing cardiopulmonary bypass(CPB). To analyze the effect of the factor related to CPB on AEP.
Methods Twenty ASA Ⅱ~Ⅲ patients undergone elective heart valve replacement were studied. The patients were induced with midazolam, etomidate, fentanyl and rocuronium used for neuromuscular block. Anesthesia was maintained with midazolam, fentanyl by target-controlled infusion(TCI). AEP, MAP, HR were recorded at 14 different time points and the statistics of CPB were also recorded. The patients were visited after recovery from anesthesia. Results AEP was decreased significantly after induction of anesthesia (P<). During incision, sternotomy, and aortic cannu