BIS检测下硬膜外复合全身麻醉用于胸科手术的临床研究

目的：采用脑电双频指数（BIS）行镇静深度监测，进一步评价硬膜外阻滞复合全麻的麻醉效果及安全性。方法：选择开胸手术患者40例，随机分为单纯全麻组（GA组）和硬膜外复合全麻组（GEA组），各20例，麻醉中维持BIS值在50～55。监测记录术前（T0）、插管前即刻（T1）、插管后1min（T2）、切皮时（T3）、去肋骨时（T4）、拔管即刻（T5）的BIS、MAP、HR及麻醉药用量，苏醒时间（停异丙酚到唤之能睁眼的时间）。结果：插管前即刻两组患者心率和平均动脉压均较术前明显降低（P〈0．05）；T2、T5时点，GA组心率和平均动脉压均明显高于术前（P〈0．05），而GEA组与术前相比无明显变化（P〉0.05）。GEA组麻醉药用量较GA组明显减少（P〈0．05），苏醒时间较GA明显缩短（P〈0．05），两组患者均无术中知晓发生。结论：脑电双频指数检测下硬膜外复合全麻用于胸科手术，可避免术中知晓的发生．减轻气管插管、拔管时心血管不良反应．减少麻醉药用量．有利于患者术后苏醒。

Clinical study of epidural and general anesthesia under BIS monitoring in the thoracic surgery

Objective： To evaluate the effects and safety of epiduarl anesthesia combined with general anesthesia under bispectarl index monitoring. Methods： 40 patients scheduled for thoracic surgery were randomly divided into general anaesthesia group （group GA, n=20） and epiduarl anesthesia combined with general anesthesia group （group GEA, n=20）, and bispectarl index was maintained between 50 and 55 during anaesthesia. BIS, MAP, HR were recorded before anesthesia （T0）, before tracheal intubation （T1）, 1 minute after tracheal intubation （T2）, at the time of skin incision （T3）, costal bone removal （T4） and extubation （T5） respectively. The quantities of anesthetic and palinesthesia time were assessed. Results： MAP and HR reduced significantly in two groups before tracheal intubation than before anesthesia （P〈0.05）, 1 minute after tracheal intubation and at the time of extubation, MAP and HR in group GA increased （P〈0.05）, and those in group GEA have no significant changes （P〉0.05）. Palinesthesia time was shorter and the quantities of anesthetic was less in group GEA than those in group GA （P〈0.05）. No case of awareness during anesthesia happened in two groups. Conclusion： Epiduarl anesthesia combined with general anesthesia under bispectarl index monitoring can avoid awareness during anesthesia, reduce the cardiovascular effects of tracheal intubation and extubation, lessen anesthetic and shorten palinesthesia time.