脑电双频谱指数和心率变异指数联合用于监测腹腔镜胆囊切除术患者麻醉深度的临床观察  

Clinical study of anesthesia depth monitoring by the combination of bispectral index and heart rate variability index for laparoscopic cholecystectomy

作　　者：朱耀民[1] 景桂霞[1] 刘翔[1] 朱宇麟[1] 

机构地区：[1]西安交通大学医学院第一附属医院麻醉科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2011年第5期623-627,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

摘　　要：目的采用脑电双频谱指数（BIS）和心率变异指数（HRVI）联合监测腹腔镜胆囊切除术患者的麻醉深度,观察手术患者中枢神经系统的抑制程度及植物神经系统对外科手术等伤害刺激的反应性,更加合理地评价腹腔镜胆囊切除术患者的麻醉深度。方法选择ASAⅠ~Ⅱ级,全麻下择期腹腔镜胆囊切除手术患者80例,依麻醉深度检测手段的不同随机分为4组：对照组（组Ⅰ）、BIS监测组（组Ⅱ）、HRVI监测组（组Ⅲ）、BIS和HRVI联合监测组（组Ⅳ）,维持BIS值40~50,HRVI值30~40。结果麻醉期间组Ⅳ丙泊酚的使用量显著低于组Ⅰ、组Ⅱ和组Ⅲ;组Ⅲ、组Ⅳ瑞芬太尼的使用量显著高于组Ⅰ和组Ⅱ;组Ⅳ苏醒时间显著短于组Ⅰ、组Ⅱ和组Ⅲ;拔管后患者烦躁例数组Ⅲ、组Ⅳ显著低于组Ⅰ和组Ⅱ。4组患者术后均未发生术中知晓。结论采用BIS和HRVI联合监测腹腔镜胆囊切除手术患者的麻醉深度,可以较为准确地反映手术患者中枢神经系统的抑制程度及植物神经系统对外科手术等伤害刺激的反应性,可更加合理地评价麻醉深度。Objective To investigate anesthesia depth monitoring by bispectral index（BIS） combined with heart rate variability index（HRVI） for laparoscopic cholecystectomy.Through this study,we can examine the depression degree of the patients＇ central nervous system and the reactivity of the autonomic nervous system to the nocuous stimulation of surgical operation,thus further properly assessing anesthesia depth for laparoscopic cholecystectomy.Methods Based on a random design and control methods,80 patients（ASA physical status Ⅰ or Ⅱ） scheduled for laparoscopic cholecystectomy surgery were enrolled in this study.The subjects were assigned into four groups： control group（group Ⅰ）,BIS monitoring group（group Ⅱ）,HRVI monitoring group（group Ⅲ） and BIS-HRVI combination monitoring group（group Ⅳ）.The values of BIS and HRVI were maintained at 40-50 and 30-40,respectively.Results The dosage of propofol used during anesthesia was significantly smaller in group Ⅳ than in groups Ⅰ and Ⅱ and Ⅲ;the dosage of remifentanil used during anesthesia was significantly higher in groups Ⅲ and Ⅳ than in groups Ⅰ and Ⅱ.Group Ⅳ had significantly shorter time of recovery than groups Ⅰ,Ⅱ and Ⅲ.There were much fewer cases of irritable patients after anesthesia in group Ⅲ and Ⅳ than in groups Ⅰ and Ⅱ.There were no aware cases after surgery among the four groups.Conclusion Our results suggest that monitoring anesthesia depth by BIS combined with HRVI for laparoscopic cholecystectomy can accurately evaluate the depression degree of the patients＇ central nervous system and the reactivity of the autonomic nervous system to the nocuous stimulation of surgical operation,thus further properly evaluating anesthesia depth for laparoscopic cholecystectomy.

关 键 词：脑电双频谱指数 心率变异指数 腹腔镜胆囊切除术 麻醉深度 

分 类 号：R614.2[医药卫生—麻醉学]