下颌骨切除患者麻醉恢复期脑电双频指数监测下拔管时机选择

目的探讨脑电双频指数(BIS)监测下行单侧下颌骨切除患者术毕麻醉恢复期在一定麻醉深度下拔除气管导管的可行性。方法选择40例单侧下颌骨切除或部分切除的患者,ASAI～II级,随机分为观察组20例和对照组20例,每组20例,术毕,观察组当患者BIS值达80±5,并满足其他拔管条件时即拔除气管导管;对照组患者则在完全清醒、BIS值达95以上时拔除气管导管。结果对照组吸痰拔管时MAP、HR较术毕有明显升高(98±6mmHgvs85±6mmHg,P<0.05;102±7次/minvs83±6次/min,P<0.01),组间比较差异也有统计学意义(P<0.05),而观察组MAP、HR平稳。拔管期间患者剧烈呛咳及躁动发生率对照组亦明显高于观察组(100%vs30%,60%vs15%)。所有患者无一例发生严重气道梗阻,拔管后均安全送返病房。结论单侧下颌骨切除手术患者于术毕麻醉恢复期在一定麻醉深度下拔除气管导管是可行的。

Observation of the best extubation opportunity after mandibulectomy using the bispectral index

Objective To examinate whether BIS value could be used to guide excubation in patients after mandibulectomy and try to find a appropriate BIS value. Methods 40 ASA I ～ II patients scheduled for complete or partial mandibulectomy were randomly divided into two groups. In group A （ n = 20） ,when the BIS values were reached 80 ± 5,the endotracheal tube was removed. In group B （ n = 20） ,when the patients were completely sober and the BIS value reached above 95,the endotracheal tubes were removed. Results After extubation,MAP and HR were significantly increased in group B（ P〈 0. 01） ,but not in group A. The rate of fierce chokes coughs and restlessness in group B was also obviously higher than that in group A. Conclusion It is feasible to use BIS values to direct extubation in the patients with mandibulectomy.