麻醉深度指数在腹腔镜胆囊切除术中麻醉监测中的作用

发布时间：2018-05-03 14:17

本文选题：麻醉深度指数 + 丙泊酚　；参考：《中国微创外科杂志》2015年04期

【摘要】：目的观察麻醉深度指数(cerebral state index,CSI)监测在腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中的作用。方法 60例择期LC,按就诊顺序编号,按随机数字表随机分为2组:实验组(n=30)和对照组(n=30),对照组采用常规全麻诱导,术中维持吸入异氟烷和笑气复合麻醉,实验组诱导和术中维持采用丙泊酚、瑞芬太尼血浆靶控给药,术中通过调节异氟烷浓度及丙泊酚和瑞芬太尼血浆靶控浓度,使CSI维持在45±5,MAP、HR在基础值±20%的范围内。观察并记录入室静卧10 min(T0)、气腹开始(T1)、气腹后5 min(T2)、气腹后10 min(T3)、气腹后15 min(T4)、气腹后20 min(T5)、气腹停止时(T6)各时点MAP、HR,比较T1、T2、T3、T4、T5、T6各时点CSI值。结果 2组CSI在T1~T6时点组内、组间比较无统计学差异(P0.05)。实验组T0~T6MAP和HR均无显著性变化(F=0.92,P=0.485;F=0.41,P=0.870),对照组MAP和HR T0~T6有显著性差异(F=10.19,P=0.000;F=10.44,P=0.000)。实验组T2~T5时点MAP、HR明显低于对照组(P0.05)。手术结束后及术后8~12 h询问所有患者,术中知晓均为0级,无不良感受,对麻醉效果满意。结论与吸入全麻比较,依靠CSI监测能较好地调控靶控输注丙泊酚、瑞芬太尼用于LC术中的麻醉深度。
[Abstract]:Objective to observe the role of cerebral state index in laparoscopic cholecystectomy (LC). Methods Sixty patients with LC were randomly divided into two groups: experimental group (n = 30) and control group (n = 30). The control group was induced by general anesthesia, and the compound anesthesia of inhaled isoflurane and nitrous oxide was maintained during the operation. In the experimental group, propofol and remifentanil were used to induce and maintain the plasma target controlled administration of propofol and remifentanil. By adjusting the concentration of isoflurane and the plasma target control concentration of propofol and remifentanil, the CSI was kept in the range of 45 卤5% 卤20%. Observation and recording of MAPHRs at different time points were observed and recorded at 10 min after insufflation, 5 min after pneumoperitoneum, 10 min after pneumoperitoneum, 15 min after pneumoperitoneum, 20 min after pneumoperitoneum, and 20 min after pneumoperitoneum, respectively. Results there was no significant difference in CSI between the two groups at T1~T6 time point (P 0.05). There was no significant difference in T0~T6MAP and HR between the experimental group and the control group. There was a significant difference in MAP and HR T0~T6 between the control group and the control group. The T2~T5 HR in the experimental group was significantly lower than that in the control group (P 0.05). After the operation and 8 hours after operation, all the patients were asked, the intraoperative knowledge was grade 0, there was no bad feeling, and the anesthetic effect was satisfactory. Conclusion compared with inhaled general anesthesia, CSI monitoring can better regulate the depth of anesthesia during LC by target-controlled infusion of propofol and remifentanil.
【作者单位】：首都医科大学附属北京朝阳医院麻醉科;
【分类号】：R614.2

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