CSI监测在肾移植手术麻醉中的应用

目的 探讨麻醉深度指数(CSI)监测肾移植手术麻醉的效果.方法 选择我院2013年7月至2015年7月急诊拟行肾移植手术麻醉的患者120例,按照随机数字表分为N组(对照组)与C组(接受麻醉深度监测),两组患者均采用相同的药物进行麻醉诱导与维持.N组患者术中维持用药仅采用丙泊酚与瑞芬太尼.瑞芬太尼浓度为0.1~0.3μg·kg-1·min-1;丙泊酚效应室浓度设定为2~3μg/ml,术中丙泊酚的输注速度依靠靶控输注技术(TCI)的原理,由Graseby3500输注泵自动调节术中丙泊酚输注的速度与剂量.C组患者术中维持药物与N组患者一致,瑞芬太尼浓度为0.1~0.3μg·kg-1·min-1.以CSI指数40~60为目标调节丙泊酚输注速度,若CSI指数低于40则降低丙泊酚输注速度与剂量,CSI指数高于60则加大丙泊酚输注速度.观察并记录两组患者年龄、体质量、手术时间、术中维持所使用丙泊酚与瑞芬太尼总量、麻醉苏醒时睁眼时间、拔管时间、恢复室停留时间.结果 与N组比较,C组性别、年龄、体质量和手术时间比较差异无统计学意义(P>0.05);C组术中维持所用丙泊酚总量低于N组(124.4±27.6)mg vs(167.6±42.8)mg],差异有统计学意义(P<0.05);C组术中维持所用瑞芬太尼总量(1911.8±197.5)μg vs(1876.1±213.4)μg]及顺式阿曲库胺总量(20.9±2.7)mg vs(21.3±2.1)mg]与N组比较差异无统计学意义(P>0.05);C组麻醉苏醒时睁眼时间(24.4±6.3)min]、拔管时间(26.6±8.9)min]及恢复室停留时间(45.2±9.4)min]均低于N组(42.5±8.2)min、(45.7±3.1)min、(72.4±12.6)min],差异有统计学意义(P<0.05).结论 CSI监测能合理指导麻醉药物用量及减少患者麻醉恢复时间.

Application of CSI monitoring in renal transplantation surgery

Objective To investigate the application of CSI (cerebral state index) monitoring in renal transplan-tation surgery. Methods One hundred and twenty patients who scheduled for renal transplantation surgery in our hospi-tal from Jul. 2013 to Jul. 2015 were randomly divided into group N (control group) and group C (receiving anesthetic depth monitoring). The patients in both groups were treated with propofol and remifentanil to maintain anesthesia. Group N applied remifentanil at concentration of 0.1~0.3μg·kg-1·min-1 and propofol at effect-site concentration of 2~3μg/ml. The propofol was infused based on target-controlled infusion (TCI), and the intraoperative infusion speed and dosage were adjusted automatically by Graseby3500 infusion pump. In group C, remifentanil was also applied at concentration of 0.1~0.3μg·kg-1·min-1, and the infusion speed of propofol was controlled by setting CSI of 40~60 as objective (reduce propofol infusion speed and dose when the CSI index was under 40 and increase propofol infusion speed when CSI in-dex was more than 60). The patients' age and weight, operation time, the use of propofol and remifentanil for intraopera-tive maintenance, the length of eye opening in anesthetic recovery, extubation time, residence time at recovery room were observe and recorded. Results There was no statistically significant difference between the two groups in age, weight, and operation time (P>0.05). Compared with group N, the total amount of propofol used during the operation in group C was smaller (124.4±27.6) mg vs (167.6±42.8) mg], and the length of eye opening (24.4±6.3) min vs (42.5±8.2) min], extuba-tion time (26.6±8.9) min vs (45.7±3.1) min] and residence time at recovery room (45.2±9.4) min vs (72.4±12.6) min] were significantly shorter (P<0.05). The two groups showed no statistically significant difference in the total amount of remi-fentanil used (1911.8±197.5)μg vs (1876.1±213.4)μg] and the total amount of cisatracurium besylate (20.9±2.7) mg vs (21.3 ± 2.1) mg], P>0.05. Conclusion CSI monitoring can reasonably guide the dosage of anesthetic drugs and re-duce the anesthesia recovery time.