BIS用于经鼻蝶垂体瘤切除术指导异氟烷吸入对麻醉恢复的影响

目的研究脑电双频指数(BIS)在显微镜经鼻蝶垂体瘤切除术中指导异氟烷吸入对麻醉恢复的影响。方法行显微镜经鼻蝶垂体瘤切除术患者30例,年龄18-65岁,ASAⅠ～Ⅱ级,随机分为BIS组和对照组,每组15例。所有患者采用标准麻醉诱导,术中以0.8%～3%异氟烷吸入和标准瑞芬太尼持续微量泵输注维持麻醉。BIS组术中调整异氟烷的浓度使BIS维持在40～60,对照组根据患者血流动力学调整异氟烷浓度。术中每5min记录患者BIS、吸入、呼气末异氟烷浓度等,手术结束记录自主睁眼、呼吸时间、拔管时间和达到Aldrete改良评分9～10的时间。结果与对照组相比,BIS组手术期间的BIS升高、术中异氟烷用量减少、呼气末异氟烷浓度降低,从手术结束至自主睁眼、自主呼吸和Aldrete9～10的时间缩短。结论BIS指导异氟烷吸入能减少经鼻蝶垂体瘤切除术中异氟烷用量,加快患者麻醉恢复,有利于尽早进行神经系统检查。

Application of BIS Index in Titration of Isoflurane to Improve Early Recovery of Patients Undergoing Microscopic Transsphenoid Surgery for Pituitary Adenoma

Objective To explore the effect of using bispectral index(BIS)in titration of isoflurane to improve early recovery of patients undergoing microscopic transsphenoid surgery for pituitary adenoma.MethodsThirty ASA Ⅰ-Ⅱpatients,aged from 18 to 65 years old,undergoing microscopic transsphenoid surgery for pituitary adenoma were randomly divided into two groups(n=15 each):BIS group and control group.Before induction,BIS sensor was applied to the forehead and connected to Aspect A-2000XP BIS monitor.All patients received standard anesthetic induction drugs,and 0.8%-3% isoflurane inhalation and standard remifentanil continuing infusion with micro-pump was used for maintenance of anesthesia.In the BIS group,the concentration of isoflurane was titrated to keep BIS at 40-60 level during the operation.In the control group,the anesthesiologist was blinded to BIS,and the concentration of isoflurane was changed according to the patients' hemodynamic changes.The hemodynamic data,BIS values,and iso?urane concentrations were recorded every 5 minutes during operation.At the end of the study,recovery criteria and Aldrete recovery scores were recorded every 5min.Neurologic assessment was performed when the Aldrete score was 9-10.ResultsBIS values were higher,the total consumption of isoflurane were lower,times to first spontaneous breathing,eye opening,extubation and Aldrete score of 9-10 and adequate neurologic assessment were shorter in the BIS group.ConclusionTitration of isoflurane using BIS monitoring in microscopic transsphenoid surgery for pituitary adenoma reduced the isoflurane consumption and shortened the recovery times from general anesthesia and contributed to early neurological assessment.