脑电双频指数用于重度烧伤患者瑞芬太尼复合丙泊酚靶控输注镇静深度的观察  

Observation of anesthesia depth in severe burn patients with target controlled infusion of propofol and remifentanil by bispectral index

作　　者：郭正纲[1] 郝建华[1] 贾晓鹏[1] 祈喆[1] 

机构地区：[1]解放军总医院第一附属医院麻醉科,北京100048

出　　处：《解放军医学杂志》2012年第4期354-356,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的评价应用脑电双频指数（BIS）监测瑞芬太尼复合丙泊酚静脉靶控输注（TCI）重度烧伤患者麻醉深度的可行性及有效性。方法选择重度烧伤择期（〈1周）行焦痂切除术患者80例,年龄18~65岁,ASAⅡ-Ⅲ级,烧伤总体表面积（TBSA）31%~50%或三度烧伤面积11%~20%,随机分为BIS组（A组）和对照组（B组）,每组40例。两组均以瑞芬太尼复合丙泊酚TCI诱导和维持,分别记录患者入室,意识消失,插管后2min,手术前,手术开始后2、15、30min,术毕,呼之睁眼和Aldrete评分9分时的平均动脉压（MAP）、心率（HR）以及术中各时间点药物靶浓度,记录患者从停药至呼之睁眼、Aldrete评分达9分的时间。结果 A组与B组比较,患者麻醉维持过程中的瑞芬太尼靶浓度（2.12±0.35ng/mlvs 2.50±0.21ng/ml）和丙泊酚靶浓度（2.54±0.22μg/ml vs 2.86±0.31μg/ml）均明显降低（P〈0.01）;A组患者在停药后呼之睁眼（7.90±0.58min vs 8.35±0.66min）、Aldrete评分9分的时间（9.15±0.69min vs 11.13±0.96min）均明显减少（P〈0.01）。两组患者从意识消失起,除插管后2min时点,其余术中各时点的MAP均较入室时的基础值明显降低（P〈0.05）;各时点的HR也较基础值明显下降（P〈0.05）。结论 BIS用于重度烧伤患者围术期瑞芬太尼复合丙泊酚TCI麻醉深度监测有助于减少丙泊酚用量,缩短患者恢复清醒时间。Objective To evaluate the feasibility and efficiency of bispectral index（BIS） for monitoring the anesthesia depth of severe burn patients with target controlled infusion（TCI） of propofol and remifentanil.Methods A total of 80 severe burns patients undergoing eschar excision（1week） were randomly divided into BIS group（group A） and control group（group B）,with 40 cases assigned in each group.These patients were 18 years to 65 years old,ASAⅡ-Ⅲ.Their total burn surface areas（TBSA） were from 31% to 50%,or 11% to 20% with three-degree burns.All patients received remifentanil and propofol for TCI intravenous anesthesia.The mean arterial pressure（MAP） and heart rate（HR） were determined at following time points,namely,entrance to the operation room,loss of consciousness,2min after intubation,before surgery,2,15,and 30min after the start of surgery,end of surgery,eye opening,and period when Aldrete score reaching 9 points,as well as the target concentrations of remifentanil and propofol.The time frames from stoppage of drug infusion to eye opening and the period when Aldrete score reaching 9 points were also recorded.Results Compared with group B,the target concentrations of remifentanil（2.12±0.35ng/ml vs.2.50±0.21ng/ml） and propofol（2.54±0.22μg/ml vs.2.86±0.31μg/ml） were significantly lower in group A during anesthetic maintenance（P0.01）.The time interval from stoppage of drug infusion to eye opening（7.90±0.58min vs.8.35±0.66min） and period when Aldrete score reaching 9 points（9.15±0.69min vs.11.13±0.96min） were significantly reduced in group A.The MAP of both groups from loss of consciousness at all time points,except 2min after intubation,was significantly lower than the basic values upon entrance into the operation room（P0.05）.The HR at all time points were significantly lower compared with the basic data（P0.05）.Conclusion BIS for monitoring the anesthetic depth of severe burns patients with TCI of propofol and remifentanil is helpful in reducing

关 键 词：丙泊酚 瑞芬太尼 靶控输注 烧伤 

分 类 号：R614[医药卫生—麻醉学]