摘要
目的分析脑电意识指数(IoC1)联合应用伤害敏感指数(IoC2)对腹腔镜手术麻醉管理的指导价值。方法前瞻性选取北京京煤集团总医院2022年6月至2023年10月在全身麻醉状态下行腹腔镜手术的100例老年患者为研究对象,按随机数字表法分为观察组和对照组,每组50例。观察组采用IoC1联合IoC2监测指导麻醉管理,对照组采用常规脑电双频指数(BIS)监测麻醉深度,并结合麻醉医生经验指导麻醉管理,比较两组入室平静时(T_(0))、麻醉诱导后(T_(1))、置入喉罩后1 min(T_(2))、二氧化碳气腹后1 min(T_(3))、拔除喉罩后1 min(T_(4))患者生命体征变化情况,比较两组苏醒拔管时间、麻醉药物用量、血管活性药物用量、IoC1、IoC2及BIS。结果两组气腹时间及循环不稳定事件发生率比较差异无统计学意义(P>0.05);观察组苏醒拔管时间短于对照组[(8.16±6.08)min比(13.10±7.09)min],丙泊酚、瑞芬太尼用量少于对照组[(382.10±201.90)mg比(465.48±213.51)mg、(0.81±0.62)mg比(1.17±0.55)mg],差异有统计学意义(P<0.05)。两组术中麻黄素、阿托品用量比较差异无统计学意义(P>0.05);观察组去甲肾上腺素用量低于对照组[(106.42±46.12)μg比(147.04±51.38)μg],差异有统计学意义(P<0.05)。两组T_(0)、T_(1)、T_(2)、T_(3)、T_(4)时点心率(HR)、平均动脉压(MAP)及对应的监测指数值(IoC1/BIS)比较差异均无统计学意义(P>0.05)。观察组T_(0)、T_(1)、T_(2)、T_(3)、T_(4)时点IoC2分别为97.46±2.46、45.28±5.08、48.64±4.51、50.44±4.21、96.08±2.69,观察组T_(3)时点IoC2值高于T_(1)、T_(2)时点,差异有统计学意义(P<0.05)。结论应用IoC1联合IoC2监测指导全身麻醉状态腹腔镜手术患者的麻醉管理,使麻醉药物应用更加量化精细,围手术期生命体征更加平稳,苏醒时间更快。
Objective To analyze the guiding value of index of consciousness 1(IoC1)and index of consciousness 2(IoC2)in anesthesia management of laparoscopic surgery.Methods A total of 100 elderly patients undergoing laparoscopic surgery under general anesthesia in the Beijing Coal Group General Hospital from June 2022 to October 2023 were prospectively selected as research objects,and they were divided into the observation group and the control group according to random number table method,with 50 cases in each group.The observation group used IoC1 and IoC2 to monitor and guide anesthesia management,while the control group used bispectral index(BIS)to monitor the depth of anesthesia,and combined with the experience of anesthesiologists to guide anesthesia management.The changes of vital signs of patients in the two groups were compared after calm entry(T_(0)),induction of anesthesia(T_(1)),implantation of laryngeal mask 1 min(T_(2)),carbon dioxide(CO 2)pneumoperitoneum 1 min(T_(3)),and removal of laryngeal mask 1 min(T_(4)).The time of resuscitation extubation,dosage of anesthetic drugs,dosage of vasoactive drugs,IoC1,IoC2 and BIS were compared between the two groups.Results The pneumoperitoneum time and incidence of circulatory instability between the two groups had no statistical differences(P>0.05).The time of resuscitation and extubation in the observation group was shorter than that in the control group:(8.16±6.08)min vs.(13.10±7.09)min,the dosage of propofol and remifentanil were lower than those in the control group:(382.10±201.90)mg vs.(465.48±213.51)mg,(0.81±0.62)mg vs.(1.17±0.55)mg,there were statistical differences(P<0.05).The amount of ephedrine and atropine between the two groups had no statistical differences(P>0.05).The dosage of norepinephrine in the observation group was lower than that in the control group:(106.42±46.12)μg vs.(147.04±51.38)μg,there was statistical difference(P<0.05).The heart rate,mean arterial pressure(MAP)and IoC1/BIS between the two groups had no statistical differences(P>0.05).The IoC2 values of T_(0),T_(1),T_(2),T_(3)and T_(4)in the observation group were 97.46±2.46,45.28±5.08,48.64±4.51,50.44±4.21 and 96.08±2.69,respectively.The IoC2 value of T_(3)was higher than that of T_(1)and T_(2)in the observation group,there were statistical differences(P<0.05).Conclusions The application of IoC1 and IoC2 to monitor and guide the anesthesia management of laparoscopic patients under general anesthesia makes the application of anesthetic drugs more quantitative and precise,the perioperative vital signs more stable,and the recovery time faster.
作者
杨丽娜
郭乃超
张伟东
齐国宁
贾浩娟
李永刚
Yang Lina;Guo Naichao;Zhang Weidong;Qi Guoning;Jia Haojuan;Li Yonggang(Department of Anesthesiology,Beijing Coal Group General Hospital,Beijing 102300,China)
出处
《中国医师进修杂志》
2025年第6期502-506,共5页
Chinese Journal of Postgraduates of Medicine
基金
北京京煤集团总医院院级科研基金项目(JJ2022-16)。
关键词
麻醉
全身
腹腔镜
意识指数
麻醉深度监测
Anesthetics,general
Laparoscopes
Index of consciousness
Anesthesia depth monitoring
