双频谱指数在心脏瓣膜置换术中的观察  

Observe different depth of routine anesthesia in cardiac valve replacement patients monitored by bispectral index (BIS)

作　　者：高成杰[1] 宁吉顺[1] 隋波[1] 李训美[1] 张汝金[2] 柳娟[2] 

机构地区：[1]济南军区总医院麻醉科,山东济南250031 [2]北京朝阳医院麻醉科,北京100020

出　　处：《中国现代医学杂志》2004年第20期70-72,76,共4页China Journal of Modern Medicine

摘　　要：目的应用脑电双频谱指数(BIS)监测常规经验麻醉下瓣膜置换术病人的麻醉深度(意识水平),观察BIS在伤害性刺激时的变化。方法选择30例瓣膜置换术病人,采用芬太尼、咪唑安定、哌库溴铵及心血管活性药物对病人实施麻醉;术中监测并有专人分别记录入室(基础值)、诱导后、插管后、切皮后、锯胸骨时、缝胸骨时及术毕BIS和MAP,HR各参数值,观察不同阶段各参数的变化。结果诱导后各参数均明显降低,虽然切皮后、锯胸骨及缝胸骨等强刺激后MAP和HR未见统计学意义的显著改变,但BIS却显著增高(P < 0.01);全部病人锯胸骨时BIS均在60(67.28±8.97)以上,缝胸骨时63(68.46±8.70)以上,而无1例低于50者。结论该组瓣膜置换术病人麻醉偏浅,尤以锯胸骨、缝胸骨及术毕等时段为甚,表现为BIS值偏高,有知晓发生;知晓可发生在临床认为满意的麻醉中;应用BIS监测,可更加合理地评价麻醉深度。Objective: To study the degree of routine anesthesia depth in cardiac valve replacement patients monitored by bispectral index (BIS), and to find out the relationship between BIS and stimulus. Methods: BIS monitoring was performed in 30 ASA Ⅲ~Ⅳ patitents who had no nerve system diseases undergoing elective cardiac valve replacement surgery. After a induction of midazolam 0.01~0.05 mg/kg and fentanyl 5~10 μg/kg, laryngoscopy and intubation were facilitated with intravenous pipecuronium 0.1~0.2 mg/kg, and anesthesia was maintained with them. The anesthesiologists were blined to the BIS value, MAP and HR which were recorded and the volatile anesthetics were titrated to maintain their clinical experience. Results: BIS, MAP and HR decreased markedly after induction. The BIS in all patients was significantly increased (P<0.01) after induction, while other parameters were unchanged significantly (P<0.05). The BIS value in all patients were more than 60 (67.28±8.97) at sternum split, and 63 (68.46±8.70) at rebuilding of chest wall. Conclusions: The incidence of awareness is occurred without BIS monitoring in those favored out actually not deep enough anesthesia in cardiac valve replacement patients. It is more resonable to monitor the routine anesthesia depth (the level of consciousness) by using BIS, and BIS value can well reflect it.

关 键 词：双频谱指数 瓣膜置换术 麻醉深度 

分 类 号：R614[医药卫生—麻醉学]