脑电双频指数监测靶控输注丙泊酚联合瑞芬太尼在老年人无痛胃镜检查中的应用

目的 探讨用脑电双频指数(BIS)监测靶控输注(TCI)丙泊酚联合瑞芬太尼在老年人无痛胃镜检查中的应用.方法 120例ASA Ⅰ～Ⅱ级接受全麻无痛胃肠镜检查的老年患者,随机分成两组:靶控输注丙泊酚联合瑞芬太尼组(A组60例)和脑电双频指数监测靶控输注丙泊酚联合瑞芬太尼组(B组60例).A组根据患者临床体征(如意识、血压、肢动)调整丙泊酚用量,B组根据BIS值调整丙泊酚和瑞芬太尼TCI血浆靶浓度,维持BIS值在55～60.比较术中血流动力学指标、丙泊酚总量、术后清醒时间和不良反应情况.结果 B组T1、T2时点平均动脉压(MAP)和心率(HR)下降幅度小于A组(P＜0.05)；B组丙泊酚用量和苏醒时间均明显小于A组(P＜0.05)；B组呛咳、呃逆,术后恶心、呕吐、躁动的发生率与A组差异无统计学意义,但呼吸抑制、心动过缓发生率明显高于A组(P＜0.05).结论 脑电双频指数监测靶控输注丙泊酚联合瑞芬太尼可安全地用于老年患者无痛胃镜检查,可减少丙泊酚用量,苏醒迅速,但需密切观察术中呼吸、循环变化.

Application of target-controlled infusion with propofol combined with remifentanyl in elderly patients with gastrointestinal endoscopy under bispectral index monitoring

Objective To discuss the advantage of bispectral index（BIS） monitoring used in gastrointestinal endoscopy, and to observe clinical effects of target-controlled infusion （TCI） propofol combined with remifentanyl in elderly patients. Methods 120 patients aged from 65 to 78 with ASA physical statusⅠ-Ⅱ were randomly divided into two groups, i. e. Group A （propofol with fentanyl）, Group B （TCI propofol and remifentanyl with BIS）. The amount of propofol was adjusted by consciousness and hemodynamics in Group A, while by BIS value in Group B. BIS was controlled at 55 - 60. The total amount of propofol and the time of wake-up, the incidence of complications in each group were recorded. Results Compared with Group A, the changes of MAP and HR at Tl and T2 were smaller in Group B （ P 〈 0.05 ） ; Compared with Group A, the total amount of propofol and the time of wake-up were less in Group B （ P 〈 0.05 ） ; Compared with Group A, the incidence of intraoperative respiratory depression and bradycardia were in- creased in Group B （P 〈 0.05 ）, there were no differences in the rest between the two groups. Conclusion Under BIS monitoring,TCI propofol and remifentanyl in elderly patients undewent gastrointestinal endoscopy may reduce propo- fol, and reach rapid recovery from anesthesia, but it needs additional management of respiration and circulation.