脑电双频指数结合镇静评分对清醒盲探气管插管中镇静作用的评估  

Evaluate Suitable Sedative Depth for Blind Tracheal Intubation with Consciousness by BIS Combined with OAA/S

作　　者：徐辉[1] 严伟民[1] 耿清胜[1] 姜虹[1] 朱也森[1] 

机构地区：[1]上海第二医科大学附属第九人民医院麻醉科,上海200011

出　　处：《口腔颌面外科杂志》2004年第3期248-251,共4页Journal of Oral and Maxillofacial Surgery

摘　　要：目的:应用脑电双频指数(BIS)结合镇静评分对清醒盲探插管中镇静作用的评估。方法：选择颌面部先天畸形或烧伤后瘢痕畸形导致困难气管插管患者38例，患者随机分为二组，Ⅰ组为咪唑安定、芬太尼组(n=21)；Ⅱ组为咪唑安定组(n=17)。Ⅰ组，盲探气管插管前，应用芬太尼(0.1mg)，咪唑安定(首剂0.04mg/kg每5～10min追加半量直至警觉／镇静观察评分(OAA/S)为2分)；Ⅱ组，仅给予咪唑安定，方法同Ⅰ组。记录用药前后BIS、心率(HR)、平均动脉压(MAP)、脉搏氧饱和度(SPO_2)变化，当OAA/S评分为2分时，记录BIS并开始经鼻腔盲探捅管，记录插管前后BIS、HR、MAP、SPO_2变化。结果：两组患者BIS值随镇静深度加深而下降，且与OAA/S评分下降一致，镇静后BIS值与OAA/S评分5分时相比有显著性差异，组间相比无显著性差异；血液动力学参数HR、MAP随OAA／S评分南5分降为2分而逐渐下降，两组HR、MAP与镇静前相比有显著差异；经鼻插管后BIS、HR、MAP均上升，与OAA/S评分2分时相比有显著性差异，Ⅱ组插管后HR上升较Ⅰ组明显两组相比有显著性差异，两组插管前后SPO_2均无显著性差异，两组患者镇静后均能耐受盲探插管操作。结论：BIS参数结合OAA/S评分能准确反映镇静深度，当镇静深度达到OAA/S评分2分、BIS76～85时行清醒盲探气管插?Objective: To evaluate the suitable sedative depth for blind tracheal intubation with consciousness by BIS combined with OAA/S. Methods: 38 patients with difficult airways caused by innate malformation or burned scar were separated into two groups, Ⅰ group (n=21) and Ⅱ group (n=17). The patients in Ⅰ group were administered MDZ (0.04mg/kg, another half of the first dose will be administered every 5minutes until the score of OAA/S dropped to 2) and fentanyl (0.1mg) for sedation; and the patients in Ⅱ group received only MDZ. To record the numbers of BIS, BP, HR and SPO_2 before administering drugs, after medication, before intubation and after achieving intubation. The BIS also should be recorded when OAA/S dropped to 2～3 scores. The all datum drawn from the study should be processed in statistical ways. Results: The values of BIS in both groups dropped with the deepening of sedation, and accorded to the drop of OAA/S, and a significant difference was observed compared with before sedation. Their HR, BP and MAP also dropped with the dropping of OAA/S, and a significant difference was observed compared with before sedation ( P<0.05 ). The values of BIS, HR and MAP of the patients in two groups had a significant ascend after intubation, and the value of HR in Ⅱ group had a higher rise than in Ⅰ group. During sedating and intubating, SPO_2 of both groups consistently maintained in normal range. Both groups of the patients can tolerance the process of the blind tracheal intubation after asuitable sedation. Conclusion: BIS combined with OAA/S was avail to evaluate exactly the depth of sedation. The patients sedated withMDZ and fentanyl had a better tolerance to intubation with consciousness and a milder cardiovascular reaction than them only with MDZ. MDZ associated with fentanyl is very suitable to make patients sedative during blind tracheal intubation with consciousness. During the sedative depth of 2 scores of OAA/S and 76～85 of BIS, it is suitable for blind tracheal intubation with consciousness to

关 键 词：评分 气管插管 咪唑安定 BIS 镇静 患者 SPO2 用脑 记录 耐受 

分 类 号：R614[医药卫生—麻醉学] R741.044[医药卫生—外科学]