脑功能状态指数对椎管内麻醉中两种药物镇静效果的评价比较  

The comparison of evaluation on the sedative effects of two drugs by cerebral state index during spinal anesthesia

作　　者：曾令全 刘艳 叶伦辉 石宗莉 吴佳穗 熊开凯 魏安宁[2] 

机构地区：[1]重庆市第十三人民医院麻醉科,400053 [2]重庆医科大学附属第二医院麻醉科

出　　处：《国际麻醉学与复苏杂志》2014年第1期9-11,共3页International Journal of Anesthesiology and Resuscitation

摘　　要：目的应用脑功能状态指数（cerebral state index，CSI）监测，观察并比较椎管内麻醉下行丙泊酚或咪达唑仑镇静效果，探讨CSI用于监测椎管内麻醉辅助镇静的可行性。方法40例在椎管内麻醉下行下腹部或下肢手术的患者，按随机数字表法随机分为两组（Ⅰ组和Ⅱ组），每组各20例，Ⅰ组以丙泊酚镇静，Ⅱ组咪达唑仑静脉注射镇静，记录警觉／镇静评分（observer＇s assessment of alertness／sedation，OAA／S）与对应的CSI值，血压及脉搏血氧饱和度（pulse oxygen saturation，SpO2），在SpO2〈92％时停止注药。结果①在SpO2〈92％前，Ⅰ组OAMS评分均可达到1分，Ⅱ组均可达到OAA／S评分3分，有6例达到2分，有2例达到1分；②两组随OAA／S评分的降低，对应的CSI、收缩压（systolic blood pressure，SBP）、舒张压（diastolic blood pressure，DBP）、SpO2有显著性的下降（P〈0．05）；③OAA／S评分≥3分时，Ⅰ组的OAA／S评分与CSI的相关系数为0．745（P〈0．01），Ⅱ组OAA／S评分与CSI的相关系数为0．684（P〈0．01）。两组相关系数比较差异无统计学意义。OAA／S评分〈3分时，Ⅰ组OAA／S评分与CSI的相关系数为0．672（P〈0．01）。结论CSI可用于监测椎管内麻醉辅助丙泊酚镇静或咪达唑仑清醒镇静，能较好地反映镇静深度的动态变化。Objective To investigate the feasibility of cerebral state index （CSI） in monitoring of sedation via observing the sedative effects of propofol or midazolam during spinal anesthesia. Mothods Forty patients undergoing lower abdominal or limb operation under spinal anesthesia were randomly divided into group Ⅰ and group Ⅱ （n=20）. The patients were intravenously administered with propofol （group Ⅰ ） or midazolam （group Ⅱ ） respectively. Observer＇s assessment of alertness/sedation score （OAA/S）, CSI, blood pressure （BP）, pulse oxygen saturation （SpO2）were recorded. Drug injection was stopped when SpO2 is lower than 92%. Results Before SpO2 is lower than 92%, OAA/S scores of all the patients of group Ⅰ were 1. In group Ⅱ , 6 patients got 2, 2 patients got 1 while the others＂ scores were 3. With the decreasing of OAA/S scores, the corresponding CSI, systolic blood pressure （SBP）, diastolic blood pressure （DBP） and SpO2 were significantly decreased in two groups（P〈0.05 ）. When the OAA/S score is not less than 3, the correlation coefficient of OAA/S score and CSI was 0.745 in group Ⅰ （P〈0.01） and 0.684 in group Ⅱ （P〈0.01） respectively. There were no significant differences of correlation coefficient between the two groups. When the OAA/S score is less than 3, the correlation coefficient of OAA/S score and CSI was 0.672 in group Ⅰ （P〈0.01）. Conclusions CSI can be used to monitor sedation with propofol or midazolam in spinal ansthesia, and can better reflect the dynamic changes of sedation depth.

关 键 词：丙泊酚 咪达唑仑 镇静 椎管内麻醉 脑功能状态指数 

分 类 号：R614[医药卫生—麻醉学]