天津医药

天津医药 ›› 2015, Vol. 43 ›› Issue (12): 1447-1449.doi: 10.11958/j.issn.0253-9896.2015.12.027

• 应用研究 • 上一篇    下一篇

不同麻醉深度对舌下微循环的影响

刘志慧1，2，王国林1，李佩铂2，谢克亮1，刘玲玲1，于泳浩1△   

  1. 1天津医科大学总医院麻醉科（邮编300052）；2包头，包头市中心医院麻醉科
  • 收稿日期:2015-03-09 修回日期:2015-07-15 出版日期:2015-12-15 发布日期:2015-12-11
  • 通讯作者: △通讯作者E-mail：yuyonghao@126.com E-mail:yuyonghao@126.com
  • 作者简介:刘志慧（1982），女，主治医师，博士在读，主要从事微循环与麻醉研究

Effect of various anaesthesia depth on the sublingual microcirculation

LIU Zhihui1, 2, WANG Guolin1, LI Peibo2, XIE Keliang1, LIU Lingling1, YU Yonghao1△   

  1. 1 Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin 300052, China; 2 Department of Anesthesiology, Baotou Central Hospital
  • Received:2015-03-09 Revised:2015-07-15 Published:2015-12-15 Online:2015-12-11
  • Contact: △Corresponding Author E-mail：yuyonghao@126.com E-mail:yuyonghao@126.com

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摘要： 目的观察不同麻醉深度对舌下微循环的影响。方法20 例行甲状腺手术且ASA 分级Ⅰ~Ⅱ级患者。静脉注射咪达唑仑0.05 mg·kg-1、舒芬太尼0.3 μg·kg-1、罗库溴铵0.6 mg·kg-1，持续静脉靶控输注丙泊酚3.0 mg·L-1 进行麻醉诱导和麻醉维持，气管插管后行机械通气。目标靶浓度每隔4 min 增加0.5 mg·L-1 进行BIS 值调节。分别在 T1[脑电双频指数（BIS）基础值]、T2（50 0.05）；T3 时PVD、 TVD、PPV 和MFI 均下降（P < 0.05）；T4 时PVD、TVD、PPV 和MFI 下降明显（P < 0.01）；T2 和T3 相比，PVD、TVD、 PPV 和MFI 差异无统计学意义（P > 0.05）。结论将BIS 值控制在≤40~50 范围，能在较好地抑制手术引起的应激反应的同时，对微循环影响较小，且能保持血流动力学的相对稳定。

关键词: 微循环, 舌, 应激, 麻醉深度, 脑电双频指数, 旁流暗视野技术

Abstract: Objective To investigate the effects of different depth of anesthesia on sublingual microcirculation. Meth⁃ ods ASA grade Ⅰ-Ⅱ patients (n=20) were scheduled for elective thyroid surgery and included in the prospective observa⁃ tional study. Midazolam 0.05 mg·kg, sufentanil 0.3 μg·kg-1 and rocuronium 0.6 mg·kg-1 were administrated intravenously to induce anesthesia which was then maintained by continuous intravenous infusion of propofol. Target medication concentra⁃ tion increased 0.5 mg·L-1, regulated based on BIS. The patients underwent endotracheal intubation and mechanical ventila⁃ tion. Sublingual microcirculations were evaluated by sidestream dark field (SDF) imaging at T1 (BIS baseline ), T2 (50 < BIS ≤ 60), T3 (40 0.05). Conclusion When BIS value sit between 40 and 50, it can best inhibit stress response and attenuate the agitation of microcirculation.

Key words: microcirculation, tongue, stress, depth of anesthesia, bispectral index (BIS), sidestream dark-field technique