摘要
目的观察麻醉深度指数(CSI)调控下妇科腹腔镜手术快通道麻醉的效果,评价CSI在快通道麻醉中应用的可行性。方法对行妇科腹腔镜手术的60例患者,随机分为对照组(C组)和实验组(T组),两组均以异丙酚、瑞芬太尼、阿曲库铵行麻醉诱导和麻醉维持并行CSI监测。C组根据麻醉医生经验用药,未以CSI反馈指导用药;T组则以CSI反馈调整异丙酚的用量,使CSI值维持在55±5之间。两组术后进行Steward评分,以术毕10 min内(≤10 min)Steward评分达4分及以上(≥4分)拔管者为快通道麻醉实施成功。记录麻醉诱导前(T0)、插管后5 min(T1)、手术开始后5 min(T2)、手术结束时(T3)、拔管前1 min(T4)、拔管后5 min(T5)的CSI值;统计麻醉药用量、拔管时间、离室时间、快通道麻醉成功率及术中知晓、术后躁动情况。结果 T组CSI值低于C组(P=0.000),且存在组间与时点的交互作用(P=0.000);两组患者T0和T6时点的CSI值差异无统计学意义(P>0.05),T组T1、T2、T3、T4、T5时点的CSI值均低于C组(P<0.05)。T组的异丙酚用量明显小于C组(P<0.05),而拔管时间和离室时间早于C组(P<0.05)。T组无术中知晓,C组有2例术中知晓,但组间比较差异无统计学意义(P>0.05);两组术后躁动差异无统计学意义(P>0.05);T组快通道麻醉成功率高于C组(P<0.05)。结论 CSI应用于调控快通道麻醉,可以避免麻醉过深或过浅,防止术中知晓;可以减少全麻药用量,加快麻醉恢复,提早拔管时间和离室时间,从而提高快通道麻醉成功率。
Objective To study the effect of fast-tracking anesthesia regulated by cerebral state index（CSI） in gynecological laparoscopic operations and evaluate the feasibility of application of CSI in fast-tracking anesthesia.Methods 60 patients with ASAⅠ～Ⅱ for gynecological laparoscopic operations were randomly divided into group C（n=30） and group T（n=30）,all patients were induced and maintained with propofol,remifentanil and atracurium while monitored by CSI.Group T adjusted the dosage of propofol according to the value of CSI which maintained at 55±5 while group C according to the experience of anesthetist.Steward′s score was assessed at 10 minutes of postoperative to test for success of fast-track anesthesia（Steward′s score 4 points or more within 10 minutes）.The value of CSI were recorded at time points：before induction（T0）,5 minutes after intubation（T1）,5 minutes after the beginning of operations（T2）,the end of operations（T3）,1 minute before extubation（T4）,5 minutes after extubation（T5）.Anesthetic dosage,extubation-time,postanesthesia care unit（PACU） stay-time,intraoperative awareness,postoperative agitation were recorded and the success rate of fast-track anesthesia of each group was calculated.Results CSI of group T was lower than that of group C（P=0.000） and there was interaction between groups and time points（P=0.000）.CSI of group T was lower than that of group C at time points T1,T2,T3,T4,T5（P0.05）,but there was no difference between groups at time points T0 and T6（P0.05）.The amount of propofol,extubation-time and PACU stay-time of group T were significantly less than those of group C（P0.05）.There was none of intraoperative awareness in group T while 2 in group C,but with no statistics difference between groups（P0.05）.There was no statistical difference in postoperative agitation between the two groups（P0.05）.The percentage of successful fast-track anesthesia of group T was higher than that of group C（P0.05）.Conclusion The application of CSI in fast-tracking anesthesia may avoid deep or light anesthesia and prevent intraoperative awareness.It can increase the percentage of successful fast-track anesthesia by reducing the anesthetic dosage,speeding up recovery,reducing extubation-time and PACU stay-time.
出处
《微创医学》
2011年第6期506-509,共4页
Journal of Minimally Invasive Medicine
基金
广西壮族自治区卫生厅科研基金项目(Z2011448)
关键词
麻醉深度指数
快通道麻醉
腹腔镜
Cerebral state index
Fast-tracking anesthesia
Laparoscope
