不同BIS值对老年胃肠手术患者应激反应及血流动力学的影响
发布时间：2018-08-04 09:31
【摘要】：目的通过对择期行胃肠道手术的老年患者在不同BIS值下的应激指标及血流动力学参数进行分析,探讨BIS监测下不同麻醉深度对老年胃肠道手术患者应激反应及血流动力学的影响,为临床调控适宜麻醉深度,有效降低应激提供理论依据。方法1选取华北理工大学附属医院2015年11月至2016年10月在静吸复合麻醉下行胃肠道手术的老年患者(65~85岁)60例,美国麻醉医师协会(ASA)分级Ⅰ~Ⅲ级,患者分为2组(按随机数字表法,n=30):L组(BIS值维持50~59),D组(BIS值维持40~49)。术中按晶胶比为2:1补液使每搏变异度(SVV)维持在10±2。2抽取患者非输液通路锁骨下静脉血,检测患者血清皮质醇(Cor)、促肾上腺皮质激素(ACT_H)、血糖(Glu)水平于麻醉诱导前(T_0)、手术开始后120min(T_4)和拔管后60min(T_6)。3记录两组患者麻醉诱导前(T_0)、气管插管后(T_1)、手术开始(T_2)、手术开始后60min(T_3)、手术开始后120min(T_4)、手术结束(T_5)、拔管后60min(T_6)的HR、MAP,监测T_1~T_5时点的SVV、CO、SV及术中血流动力学的波动情况。记录术中液体出入量、全麻药物用量,术后苏醒和拔管时间并随访患者术中知晓情况及有无麻醉相关并发症。4应用SPSS17.0统计软件进行统计分析,计量资料以均数±标准差((?)±s)表示,组间相比采取用两独立样本t检验,组内比较采取重复测量方差分析,计数资料比较采用卡方检验。P0.05为差异有统计学意义。结果1两组患者的基本资料(年龄、性别、BMI、ASA分级等)差异无统计学意义(P0.05),具有临床可比性。两组患者入室后生命体征等指标均衡可比,差异无统计学意义(P0.05)。2与T_0比较,在T_4、T_6时点两组ACT_H、皮质醇和Glu水平均显著升高(P0.05或P0.01),证实了术中机体发生了较强的应激反应;D组患者皮质醇在T_4、T_6明显低于L组(P0.05),说明较低BIS值对HPA轴的抑制更充分从而减少Cor的分泌。3与T_0比,L组患者HR在T_4~T_6明显增加(P0.05或P0.01),MAP在T_1、T_2显著下降(P0.05)在T_4~T_6增加(P0.05或P0.01);D组HR各时点较T_0无明显改变(P0.05),MAP在T_1~T_5下降(P0.05或P0.01);同时D组HR在T_4~T_6明显低于L组(P0.05),MAP在T_3~T_6低于L组(P0.05),D高血压发生率低于L组(P0.05),说明BIS值维持在40~49能有效减轻老年胃肠手术患者血流动力学的波动。术中各时点的SVV、CO、SV,两组患者差异无统计学意义(P0.05)。4 D组术中丙泊酚用量和补液量明显多于L组,差异有统计学意义(P0.05),瑞芬太尼用量、出血量及尿量在两组患者中,差异无统计学意义(P0.05)。D组苏醒时间和拔管时间长于L组,差异有统计学意义(P0.05)。术后随访两组患者均无术中知晓及麻醉相关并发症发生。结论1在老年患者胃肠道手术中麻醉深度调控BIS值范围在40~49较维持50~59减少应激激素皮质醇水平,更好的抑制机体的应激反应。2调控在BIS值范围40~49可维持更平稳的HR、MAP,减少血流动力学的波动。3调控BIS值在40~59均保证手术顺利完成且无麻醉相关并发症及术中知晓发生。但维持BIS值50~59可节省液体和丙泊酚用量,减少苏醒及拔管时间,有助于老年人麻醉后的早期恢复。
[Abstract]:Objective to investigate the stress and hemodynamic parameters of the elderly patients undergoing elective gastroenteric surgery under different BIS values, and to explore the effects of different depth of anesthesia on the stress response and hemodynamics of the elderly patients with gastrointestinal surgery under BIS monitoring, and to provide a theoretical basis for the clinical regulation of anesthesia depth and the effective reduction of stress. Methods 1 according to method 1, 60 cases of elderly patients (65~85 years old) were selected from November 2015 to October 2016 in the Affiliated Hospital of North China Polytechnic University. The American anesthesiologist Association (ASA) classification was grade I ~ III, and the patients were divided into 2 groups (according to random number table method, n=30): L group (BIS value maintained 50~59), D group (BIS value maintained 40~49). The gel ratio was 2:1 rehydration (SVV) for the subclavicular venous blood per stroke change (SVV), and the serum cortisol (Cor), adrenocorticotropin (ACT_H), blood glucose (Glu) level before induction of anesthesia (T_0), and two groups of patients before the anesthesia induction (T_0), 120min (T_4) and 60min (T_6).3 after extubation after the operation. After endotracheal intubation (T_1), operation start (T_2), 60min (T_3) after operation, 120min (T_4) after operation, operation end (T_5), HR of 60min (T_6) after extubation, MAP. The intraoperative knowledge and the complications related complications of.4 were statistically analyzed with SPSS17.0 software, and the measurement data were measured with mean + standard deviation ((?) + s). Compared with two independent sample t tests, the group adopted repeated measurement of variance analysis, and counting data compared with chi square test.P0.05 was statistically significant. Results there was no significant difference in the basic data (age, sex, BMI, ASA classification, etc.) in 1 groups of patients (P0.05), and there was a clinical comparability. There was no statistically significant difference between the two groups after entering the room. There was no significant difference (P0.05),.2 and T_0, in T_4, T_6 time point two, and the level of cortisol and Glu increased significantly (P0.05 or P0.01). In the group D, the cortisol in T_4, T_6 was significantly lower than that of the L group (P0.05), indicating that the lower BIS value was more sufficient to reduce the HPA axis, thus reducing the.3 and T_0 ratio of Cor. 1); there was no obvious change in the time points of HR in group D (P0.05), MAP in T_1~T_5 (P0.05 or P0.01), while D group HR in T_4~T_6 was lower than that of L group, and the incidence of hypertension was lower than that of the group. SVV, CO, SV, there was no significant difference between the two groups (P0.05) the dosage of propofol and the amount of rehydration in the group.4 D were significantly more than those in the L group. The difference was statistically significant (P0.05). There was no significant difference between the dosage of remifentanil, the amount of bleeding and the amount of urine in the two groups (P0.05), the waking time and extubation time of the.D group were longer than those in the L group, the difference was statistically significant. Meaning (P0.05). Two groups of patients were followed up without intraoperative awareness and anesthesia related complications. Conclusion 1 in the elderly patients with gastrointestinal surgery, the range of anaesthesia in the range of BIS value is less than the 40~49 maintenance 50~59 to reduce the stress hormone cortisol level, better inhibition of the body's stress response.2 regulation in the BIS range 40~49 can maintain a more stable HR, M AP, reducing the fluctuation of hemodynamics.3 control BIS value in 40~59 ensure the smooth completion of the operation without anesthesia related complications and intraoperative awareness. But the maintenance of BIS value 50~59 can save the dosage of liquid and propofol, reduce the awakening and extubation time, and help the elderly to recover early after anesthesia.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614
本文编号：2163410
[Abstract]:Objective to investigate the stress and hemodynamic parameters of the elderly patients undergoing elective gastroenteric surgery under different BIS values, and to explore the effects of different depth of anesthesia on the stress response and hemodynamics of the elderly patients with gastrointestinal surgery under BIS monitoring, and to provide a theoretical basis for the clinical regulation of anesthesia depth and the effective reduction of stress. Methods 1 according to method 1, 60 cases of elderly patients (65~85 years old) were selected from November 2015 to October 2016 in the Affiliated Hospital of North China Polytechnic University. The American anesthesiologist Association (ASA) classification was grade I ~ III, and the patients were divided into 2 groups (according to random number table method, n=30): L group (BIS value maintained 50~59), D group (BIS value maintained 40~49). The gel ratio was 2:1 rehydration (SVV) for the subclavicular venous blood per stroke change (SVV), and the serum cortisol (Cor), adrenocorticotropin (ACT_H), blood glucose (Glu) level before induction of anesthesia (T_0), and two groups of patients before the anesthesia induction (T_0), 120min (T_4) and 60min (T_6).3 after extubation after the operation. After endotracheal intubation (T_1), operation start (T_2), 60min (T_3) after operation, 120min (T_4) after operation, operation end (T_5), HR of 60min (T_6) after extubation, MAP. The intraoperative knowledge and the complications related complications of.4 were statistically analyzed with SPSS17.0 software, and the measurement data were measured with mean + standard deviation ((?) + s). Compared with two independent sample t tests, the group adopted repeated measurement of variance analysis, and counting data compared with chi square test.P0.05 was statistically significant. Results there was no significant difference in the basic data (age, sex, BMI, ASA classification, etc.) in 1 groups of patients (P0.05), and there was a clinical comparability. There was no statistically significant difference between the two groups after entering the room. There was no significant difference (P0.05),.2 and T_0, in T_4, T_6 time point two, and the level of cortisol and Glu increased significantly (P0.05 or P0.01). In the group D, the cortisol in T_4, T_6 was significantly lower than that of the L group (P0.05), indicating that the lower BIS value was more sufficient to reduce the HPA axis, thus reducing the.3 and T_0 ratio of Cor. 1); there was no obvious change in the time points of HR in group D (P0.05), MAP in T_1~T_5 (P0.05 or P0.01), while D group HR in T_4~T_6 was lower than that of L group, and the incidence of hypertension was lower than that of the group. SVV, CO, SV, there was no significant difference between the two groups (P0.05) the dosage of propofol and the amount of rehydration in the group.4 D were significantly more than those in the L group. The difference was statistically significant (P0.05). There was no significant difference between the dosage of remifentanil, the amount of bleeding and the amount of urine in the two groups (P0.05), the waking time and extubation time of the.D group were longer than those in the L group, the difference was statistically significant. Meaning (P0.05). Two groups of patients were followed up without intraoperative awareness and anesthesia related complications. Conclusion 1 in the elderly patients with gastrointestinal surgery, the range of anaesthesia in the range of BIS value is less than the 40~49 maintenance 50~59 to reduce the stress hormone cortisol level, better inhibition of the body's stress response.2 regulation in the BIS range 40~49 can maintain a more stable HR, M AP, reducing the fluctuation of hemodynamics.3 control BIS value in 40~59 ensure the smooth completion of the operation without anesthesia related complications and intraoperative awareness. But the maintenance of BIS value 50~59 can save the dosage of liquid and propofol, reduce the awakening and extubation time, and help the elderly to recover early after anesthesia.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614
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