脑电双频指数指导靶控输注丙泊酚麻醉探究ERCP最佳麻醉深度

发布时间：2018-09-19 14:27

【摘要】：目的:探讨ERCP手术中,BIS指导靶向输注丙泊酚在不插管深度镇静状态下,对老年患者和年轻患者最佳的麻醉深度。方法:收集自2016年8月至2017年1月,行ERCP的患者109例,所有患者ASA分级为I-II级。根据年龄以及麻醉深度的不同分为四组,每组患者23-31例,均给予靶控输注(TCI)丙泊酚复合芬太尼麻醉,诱导后根据BIS值调整TCI浓度至所需范围,调整幅度为0.2ug/ml递增或递减。第一组(A组)为术中维持BIS值56~70的65岁以下患者;第二组(B组)为术中维持BIS值40~55的65岁以下患者;第三组(C组)为术中维持BIS值56~70的65岁以上患者;第四组(D组)为术中维持BIS值40~55的65岁以上患者。BIS值降到所需范围且睫毛反射消失后开始内镜操作。观察并记录一下资料:患者姓名、性别、年龄、身高、体重、体重指数、肝功能分级、手术时间等一般情况;T0(患者入室)、T1(诱导后)、T2(进镜时)、T3(造影时)、T4(手术结束)、T5(患者睁眼,并可做简单应答)时生命体征(HR、MAP、SPO2、BIS)的变化情况;患者术中体动、呼吸抑制、呛咳、误吸、血管活性药使用情况、低HR、术中知晓及总的不良事件次数;各组的丙泊酚总用量、苏醒时间(停药至患者睁眼并能简单回答问题的时间)、T1及T5时效应室浓度、苏醒时BIS值。结果:四组患者术中不良事件发生情况中,在各组间均无显著性差异(p0.05);患者术前及术中的生命体征变化情况:MAP变化中可见T1点C组MAP比D组下降幅度小,差异具有统计学意义(p0.05);四组HR变化过程中,组间无统计学差异(p0.05);SPO2变化过程中,T1、T2时C组SPO2显著高于D组,A+C组SPO2显著高于B+D组(p0.05);丙泊酚总用药量中A组显著低于B组,C组显著小于D组,A+C组显著小于B+D组(p0.05);T1丙泊酚效应室浓度中C组显著小于D组(p0.05);T5丙泊酚效应室浓度中A组显著大于B组,A+C组显著大于B+D组(p0.05),苏醒时间组间无统计学差异。结论:在ERCP麻醉中,老年患者及年轻患者均适合BIS值维持在55~70的麻醉深度。
[Abstract]:Objective: to investigate the best anesthetic depth of propofol directed by ERCP under the condition of deep sedation without intubation. Methods: 109 patients with ERCP were collected from August 2016 to January 2017. All patients were classified as I-II grade by ASA. Patients in each group were divided into four groups according to their age and depth of anesthesia. Each group was anesthetized with target controlled infusion of (TCI) propofol and fentanyl. After induction, the concentration of TCI was adjusted to the required range according to the value of BIS, and the adjustment range was 0.2ug/ml increasing or decreasing. The first group (group A) was a group of patients under 65 years of age who maintained a BIS value of 5670 during operation, the second group (group B) was a group of patients under 65 years of age who maintained an intraoperative BIS value of 400.55, the third group (group C) was a group of patients over 65 years of age who maintained an intraoperative BIS value of 5670. The fourth group (group D) was a group of patients over 65 years of age who maintained a BIS value of 40 to 55 during the operation. The value of BIS decreased to the required range and the eyelash reflex disappeared and the endoscopic operation began. Observe and record the data: patient's name, sex, age, height, body mass index, liver function grade, operation time, etc. The changes of vital signs (HR,MAP,SPO2,BIS) during operation, body movement, respiratory inhibition, choking cough, aspiration, use of vasoactive drugs, low awareness and total adverse events during HR, total dosage of propofol in each group were also observed. The recovery time (the time when the patient opened his eyes and could simply answer the question) was measured at T1 and T5, and the BIS value at the waking time. Results: there was no significant difference in the incidence of intraoperative adverse events among the four groups (p0. 05), and the changes of vital signs before and during operation showed that the decrease of MAP in T1 point C group was smaller than that in D group. The difference was statistically significant (p0. 05). There was no statistical difference (p0. 05) in the course of SPO 2 change among groups, SPO2 in group C was significantly higher than that in group D, SPO2 in group A and C was significantly higher than that in group B (p0. 05), total dosage of propofol in group A was significantly lower than that in group B and group C was significantly lower than that in group D (P 0. 05). The concentration of propofol effect chamber in group C (p0.05) was significantly lower than that in group D (p0.05). The concentration of propofol effect chamber in group A was significantly higher than that in group B (p0.05). There was no significant difference in recovery time between group C and group B (p 0.05). Conclusion: in ERCP anesthesia, both elderly patients and young patients are suitable for maintaining the BIS at a depth of 550.70.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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