摘要
目的探讨麻醉深度指数(CSI)应用于老年患者胃镜检查的优势,观察比较单纯靶控输注TCI异丙酚和TCI瑞芬太尼复合异丙酚两种方法在老年患者胃镜检查中的应用价值及不良反应。方法 90例ASAⅠ、Ⅱ级接受胃镜检查的患者(65岁以上),随机分成3组(n=30):单纯TCI异丙酚组(A组),CSI监测TCI异丙酚组(B组),CSI监测TCI瑞芬太尼复合异丙酚组(C组)。A组根据患者意识和血流动力学调整血浆异丙酚TCI靶浓度,B、C组根据CSI值和血流动力学调整异丙酚和(或)瑞芬太尼TCI血浆靶浓度,检查中维持CSI值40～60。分别记录异丙酚总量,苏醒和应答时间,呼吸抑制、心动过缓、不自主体动、呃逆、恶心和呕吐等不良反应情况。结果 3组患者均顺利完成检查,与A组比较,B、C组的异丙酚总量减少,苏醒和应答时间均缩短,检查中体动减少(P<0.05),与B组比较,C组异丙酚总量减少,苏醒时间缩短(P<0.05),应答时间和体动反应差异无显著性(P>0.05),与A、B组比较,C组发生呼吸抑制、心动过缓的概率明显增高(P<0.05),3组呛咳、呃逆、恶心、呕吐的发生率差异无显著性(P>0.05)。结论 CSI监测下TCI瑞芬太尼复合异丙酚用于老年患者胃肠镜检查可以达到更合理的麻醉深度而减少检查中不良刺激反应,并减少异丙酚用量,以便麻醉快速苏醒,缺点是需加强呼吸循环管理。
[Objective] To discuss the advantage of cerebral state index（CSI） monitoring used in elderly patients undergoing gastroscopy,and to observe and compare values and side-effects of two ways of anesthesia.Target-controlled infusion（TCI） single propofol and remifentanyl combined with propofol.[Methods] Ninety patients above 65 years of age with ASA physical status Ⅰ-Ⅱ were randomly divided into three groups.Group A（TCI propofol）,Group B（TCI propofol with CSI）,and Group C（TCI remifentanyl and propofol with CSI）.Plasma target concentration of propofol was adjusted by consciousness and hemodynamics in Group A,while by both CSI and hemodynamics in Group B.CSI was controlled at 40-60.The total a mount of propofol,the time of wake-up and word-response,the incidence of intraoperative respiratory depression,bradycardia,involuntary movement,hiccup,postoperative nausea and vomit of each group were recorded.[Results] Compared with that in Group A,the total a mount of propofol,the time of wake-up and word-response,involuntary movement was less in Group B and C（P〈0.05）;compared with that in Group B,the former two were reduced（P〈0.05）,but there were no differences in the latter two in Group C（P〉0.05）;compared with that in Group A and B,the incidence of intraoperative respiratory depression and bradycardia were increased,there were no differences in the rest in all the three groups（P〉0.05）.[Conclusion] Under CSI monitoring,the value of TCI remifentanyl and propofol in elderly patients undergoing gastroscopy is to reach more reasonable depth of anesthesia which can reduce adverse responses,and to reach rapid recovery from anesthesia,though it needs addition a management of respiration and circulation.
出处
《中国内镜杂志》
CSCD
北大核心
2011年第6期600-602,606,共4页
China Journal of Endoscopy
关键词
麻醉深度指数
老年人
胃镜
麻醉和镇痛
cerebral state index
elderly patient
gastroscopes
anesthesia and analgesia
