以脑电双频谱指数为导向实施全身麻醉镇静深度管理的分析

目的比较"经验麻醉"与"精确麻醉"的区别,找出"经验麻醉"的不足并提出改进措施。方法随机选择ASAⅠ～Ⅱ级,拟在气管内插管全麻下行颈部、腰背部、腹部手术患者60例,年龄18～55岁,无药物滥用史,入室后常规监测NBP、SpO2、HR、ECG、PETCO2,入室后静注盐酸戊乙奎醚0.01 mg/kg,咪达唑仑0.05 mg/kg,麻醉诱导为舒芬太尼0.3μg/kg,顺式阿曲库铵0.015 mg/kg,丙泊酚1.5～2 mg/kg,麻醉维持药物:TCI丙泊酚和瑞米芬太尼。所有患者插管顺利。按脑电双频谱指数(BIS)监测时间点的不同,随机分为两组,试验组为手术体位摆放完成、术者开始消毒铺巾后,开机进行监测;对照组为麻醉诱导前开始监测。观察并记录:基本生命体征,BIS值,丙泊酚和瑞米芬太尼TCI浓度。结果两组患者基本生命体征变化差异无统计学意义(P>0.05);BIS值变化差异有统计学意义(P<0.05),试验组手术开始时BIS值在40～60间相符率为73.3%(22/30)。结论 加强脑功能监测非常必要。

Analysis on sedation depth manage of general anaesthesia by BIS

Objective To compare the difference between experience anaesthesia with precise anaesthesia,and discover the insufficiency of experience anaesthesia,proposes the corrective measure.Methods 60 cases,ASAⅠ～Ⅱ,18～55 years old patients,plan to carry out the neck/the lower back and the abdominal section operations in the general anesthesia of the trachea to insert a tube,non-substance abuse history,monitored NBP/SpO2/HR/ECG/PETCO2 routinely after patients entered into the operation rooms.The medicines before operations were penehyclidine hydrochloride 0.01mg/kg and midazolam 0.05mg/kg.The anesthesia induction medicine were sufentanil 0.3ug/kg,cis-atracurium 0.015mg/kg and propofol 1.5～2 mg/kg;the anaesthesia maintenance medicine were TCI(target controlled injection) propofol and remifentanil.All patients inserted a tube smoothly.They were divided into 2 groups randomly according to the time point of BIS monitor.In the test group,BIS monitor was performed after the body posture fixed and the skin disinfect;in the other group,BIS monitor was performed before anesthesia induction.The data of basic life symptoms,BIS value,density of TCI propfol and remifentanil were observed and recorded.Results There was no statistical difference between the two groups(P>0.05).The changes of basic life symptoms and BIS value had statistical significance(P<0.05).The Probability of BIS value(40 to 60) was 73.3%(22/30) in the test group.Conclusion Improvement of the brain function monitor is essential.