脑状态指数指导右美托咪定在辅助麻醉中应用的观察

目的 探讨脑状态指数(CSI)在右美托咪定(DEX)辅助麻醉中的应用价值.方法 急诊手或上肢外伤患者44例完全随机分为观察组(18例)和对照组(26例).对照组仅用罗哌卡因(浓度0.375％,40 ml)予以臂丛阻滞麻醉,观察组于臂丛麻醉后给予DEX,负荷量0.8μg/kg微量泵10 min静脉泵入,继以0.4～0.7 μg/(kg·h)的速度维持CSI水平在60～80.记录患者麻醉前(T0)、麻醉后5 min(T1)(观察组为DEX负荷量静注5 min后)、麻醉后10 min(T2)(观察组为DEX负荷量静脉注射10 min)、麻醉后30 min(T3)各时间点的Ramsay评分、CSI值、肌电指数(EMG)值.结果 观察组T2、T3时点的Ramsay评分(平均秩次)高于对照组,差异有统计学意义(分别为16.11比8.31,P=0.003;31.28比16.42,P=0.000).2组间T0、T1时点的CSI、EMG比较差异无统计学意义；观察组T2、T3时点的CSI值低于对照组,差异有统计学意义[分别为69.0(55.8,81.5)比86.0(73.5,92.5),P=0.025；80.0(73.8,88.0)比89.0(85.0,91.2),P=0.019]；观察组T2、T3时点的EMG值(中位数)低于对照组,差异有统计学意义[分别为23.0(10.0,71.8)比93.0(73.0,100.0),P=0.007;80.0(39.5,83.5)比96.0(70.5,100.0),P=0.036].Spearman相关性检验结果示CSI、EMG均与Ramsay评分呈负相关(分别为r=-0.533,P=0.000；r=-0.538,P=0.000).结论 CSI、EMG与Ramsay评分有良好的相关性,将CSI控制在60 ～ 80用于指导DEX在非全身麻醉患者中的应用,可以使患者达到理想的镇静状态,机体完全放松.

Clinical observation of dexmedetomodine in assisted anesthesia guided by cerebral stage index

Objective To evaluate the value of dexmedetomodine （DEX） in the assisted anesthesia guided by cerebral stage index（CSI）.Methods 44 patients with acute hand and upper limber trauma were randomly divided into dexmedetomodine group （group D,18 cases） and controller group（group C,26 cases）.Only ropivacaine （0.375% concentration,40 ml） was used in group C,0.8 μg/kg of DEX were used in group D within 10 min as a bolus,and 0.4-0.7 μg/（kg · h）of DEX were infused continuously monitored by CSI within 60-80 range.Ramsay score,CSI value and electromyographic （EMG） value were recorded on before anesthesia （T0）,5 minutes after anesthesia （T1） （5 minutes after bolous of DEX in group D）,10 minutes after anesthesia （T2） and 30 minutes after anesthesia （T3）.Results Ramsay score （mean rank）in group D were higher than that of group C with statistical difference in T2 and T3（respectively 16.1 vs 8.31,P =0.003; 31.28 vs 16.42,P =0.000） ; CSI value （median） in group D were lower than that of group C in T2 and T3 [respectively 69.0 （55.8,81.5） vs 86.0 （73.5,92.5）,P=0.025; 80.0（73.8,88.0） vs 89.0（85.0,91.2）,P=0.019]; EMG value （median） in group D were lower than that of group C in T2 and T3 [respectively 23.0 （10.0,71.8） vs 93.0 （73.0,100.0）,P =0.007 ; 80.0 （39.5,83.5） vs 96.0 （70.5,100.0）,P =0.036].By spearman correlation test,there were negnetive correlation between CSI,EMG and Ramsay score（respectively r =-0.533,P =0.000; r =-0.538,P =0.000）.Conclusions There is a good correlation among Ramsay score and CSI,EMG.CSI within 60-80 range,which can guide DEX in patients except general anesthesia to obtain good sedation and muscle relaxation.