麻醉深度指数在腹腔镜胆囊切除术中麻醉监测中的作用  

Value of Cerebral State Index During Anesthetic Monitoring in Laparoscopic Cholecystectomy

作　　者：李志刚[1] 于金辉[1] 李明颖[1] 王振元[1] 

机构地区：[1]首都医科大学附属北京朝阳医院麻醉科,北京100043

出　　处：《中国微创外科杂志》2015年第4期298-300,304,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的观察麻醉深度指数（cerebral state index,CSI）监测在腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）中的作用。方法 60例择期LC,按就诊顺序编号,按随机数字表随机分为2组：实验组（n=30）和对照组（n=30）,对照组采用常规全麻诱导,术中维持吸入异氟烷和笑气复合麻醉,实验组诱导和术中维持采用丙泊酚、瑞芬太尼血浆靶控给药,术中通过调节异氟烷浓度及丙泊酚和瑞芬太尼血浆靶控浓度,使CSI维持在45±5,MAP、HR在基础值±20%的范围内。观察并记录入室静卧10 min（T0）、气腹开始（T1）、气腹后5 min（T2）、气腹后10 min（T3）、气腹后15 min（T4）、气腹后20 min（T5）、气腹停止时（T6）各时点MAP、HR,比较T1、T2、T3、T4、T5、T6各时点CSI值。结果 2组CSI在T1~T6时点组内、组间比较无统计学差异（P〉0.05）。实验组T0~T6MAP和HR均无显著性变化（F=0.92,P=0.485;F=0.41,P=0.870）,对照组MAP和HR T0~T6有显著性差异（F=10.19,P=0.000;F=10.44,P=0.000）。实验组T2~T5时点MAP、HR明显低于对照组（P〈0.05）。手术结束后及术后8~12 h询问所有患者,术中知晓均为0级,无不良感受,对麻醉效果满意。结论与吸入全麻比较,依靠CSI监测能较好地调控靶控输注丙泊酚、瑞芬太尼用于LC术中的麻醉深度。Objective To observe the value of cerebral state index（CSI） during laparoscopic cholecystectomy（LC）.Methods A total of 60 patients undergoing LC were randomly divided into two groups according to random number table：experimental group（n = 30） and control group（n = 30）.The control group was given conventional induction of general anesthesia with intraoperative isoflurane inhalation and nitrous oxide compound anesthesia,and the experimental group was given propofol induction and intraoperative maintenance,plasma target controlled infusion with remifentanil,and intraoperative adjusting the concentration of isoflurane and target controlled concentration of propofol and remifentanil to keep CSI between 45 ± 5,plus MAP and HR within scopes of the basic value plus or minus 20%.The MAP and HR values at operation room repose for 10 min（T0）,pneumoperitoneum（T1）,5 min after pneumoperitoneum（T2）,10 min after pneumoperitoneum（T3）,15 min after pneumoperitoneum（T4）,20 min after pneumoperitoneum（T5）,and stopping pneumoperitoneum（T6） of the two groups were observed and recorded.The CSI measures at each time point were observed and compared.Results The CSI at T1-T6 points had no statistical difference between the two groups（P 0.05）.In the experimental group,the MAP and HR at T0-T6 had no significant difference（F = 0.92,P = 0.485; F = 0.41,P = 0.870）,while in the control group,the MAP and HR at T0-T6 had significant difference（F = 10.19,P = 0.000; F = 10.44,P = 0.000）.At T2-T5 time points,the MAP and HR in the experimental group were significantly lower than those in the control group（P 0.05）.All the patients were required at the end of surgery and 8-12 h after surgery,showing grade of intraoperative awareness,no negative feelings,and satisfying anesthetic effects.Conclusion Cerebral state index reflects objectively the target controlled infusion of propofol and remifentanil and can be used in laparoscopic cholecystectomy.

关 键 词：麻醉深度指数 丙泊酚 瑞芬太尼 靶控输注 腹腔镜胆囊切除术 

分 类 号：R614.2[医药卫生—麻醉学]