BIS指导给药在重型颅脑损伤患者麻醉诱导阶段的应用

[目的]探讨在重型颅脑损伤(severe traumatic brain injury,STBI)患者的麻醉诱导阶段,脑电双频谱指数(bispectral index,BIS)指导下给药的应用价值.[方法]将52例STBI拟行手术治疗的患者随机分为观察组和对照组,每组26例.观察组依据BIS值给药诱导,静脉缓慢推注丙泊...

Application of BIS-guided Administration in Anesthesia Induction Stage of Patients with Severe Traumatic Brain Injury

[Objective]To investigate the application value of bispectral index(BIS)in the anesthesia induction stage of patients with severe traumatic brain injury(STBI).[Methods]Fifty-two patients with severe traumatic brain injury(STBI)were randomly divided into the observation group(group N,n=26)and the control group(group C,n=26).In group N,propofol was slowly injected according to the BIS value.In brief,when the BIS value reached the predetermined value(40?60),sufentanil 0.4μg/kg and rocuronium 0.6mg/kg were injected immediately.Then tracheal intubation was performed when muscle relaxation was satis-factory.In group propofol was slowly injected according to the doctor’s clinical experience and patient’s weight.The other administrations and intubation methods were the same as those of group N.Mean arterial pressure(MAP),heart rate(HR)and BIS value were recorded before induction(T0),before tracheal intuba-tion(T1),and 1(T2),5(T3),10(T4)minutes afterwards.Venous blood samples were collected to deter-mine the plasma cortisol(COR)level at T0,T1 and T3.Besides,the dosage of propofol used during induction was recorded.[Results]Compared to T0,the MAP,HR and BIS value in both groups were significantly de-creased after induction and increased after tracheal intubation(P<0.05).Compared with Group N,MAP and BIS value had a significantly wider fluctuation range in Group C(P<0.05).At the point of T0.COR levels in both groups were higher than the normal level.After tracheal intubation,COR levels in both groups were in-creased?but there wavS no significant difference between the two groups(P>0.05).The dosage of propofol in group N was(1.1±0.3)mg/kg,which was significantly lower than that in group C(1.7±0.2)mg/kg;the difference was statistically significant(P<0.05).[Conclusions]In the anesthesia induction stage of patients with severe traumatic brain injury,administration under the guidance of BIS can not only ensure the depth of anesthesia,but also inhibit the stress reaction caused by endotracheal intubation.It can also reduce the dosage of propofol used,avoid the occurrence of low BIS value,and make the hemodynamics more stable,which ivS obviously better than the normal administration.