不同镇静深度监测麻醉用于玻璃体切割术效果的比较  

Comparison of efficacy of different sedation depths of monitored anesthesia care in vitrectomy

作　　者：孙瑞强[1] 高雪松[1] 王全[1] 王淑珍[1] 陈松[1] 薛玉良[2] 

机构地区：[1]天津市眼科医院南开大学眼科医院麻醉科天津市眼科学与视觉科学重点实验室天津市眼科研究所,300020 [2]泰达国际心血管病医院麻醉科,天津市300457

出　　处：《中华麻醉学杂志》2016年第1期68-70,共3页Chinese Journal of Anesthesiology

基　　金：天津市卫生局科技基金（2014KZ070）

摘　　要：目的 比较不同镇静深度监测麻醉（MAC）用于玻璃体切割术的效果.方法 拟在MAC下行择期玻璃体切割术患者96例,年龄40 ～ 64岁,性别不限,体重指数≤35 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法将患者分为2组（n=48）：浅镇静组（Ⅰ组）和深镇静组（Ⅱ组）.麻醉诱导：静脉注射咪达唑仑0.02 mg/kg和舒芬太尼0.15μg/kg.麻醉维持：Ⅰ组静脉输注异丙酚0.5～2.0 mg·kg-1·h-1,维持BIS值＞80;Ⅱ组静脉输注异丙酚2～6 mg· kg-1·h-1,维持BIS值65～80.记录手术操作期间未预料头部活动、SpO2低于90％、打鼾、眼心反射和术后恶心呕吐的发生率及术后仰卧位转俯卧位的时间.结果 与Ⅰ组比较,Ⅱ组未预料头部活动、Sp02低于90％、打鼾的发生率升高,术后仰卧位转俯卧位的时间延长（P＜0.05）,术后恶心呕吐和眼心反射的发生率差异无统计学意义（P＞0.05）.结论 浅镇静MAC（BIS值＞80）用于玻璃体切割术效果优于深镇静MAC（BIS值65～80）.Objective To compare the efficacy of different sedation depths of monitored anesthesia care （MAC） in vitrectomy.Methods Ninety-six patients of both sexes,aged 40-64 yr,with body mass index ≤ 35 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective vitrectomy,were randomly divided into 2 groups （n =48 each） using a random number table：mild sedation group （group Ⅰ） and profound sedation group （group Ⅱ）.Anesthesia was induced with iv midazolam 0.02 mg/kg and sufentanil 0.15 μg/kg.Anesthesia was maintained with iv infusion of propofol 0.5-2.0 mg · kg-1 · h-1 maintaining bispectral index （BIS） value〉80 in group Ⅰ,or with iv infusion of propofol 2-6 mg · kg-1 · h-1 maintaining BIS value at 65-80 in group Ⅱ.The occurrence of unexpected head movement,SPO2〈90%,snoring,and oculocardiac reflex during the procedure,postoperative nausea and vomiting,and the time when the patients in supine position were turned to prone position were recorded after surgery.Results Compared with group Ⅰ,the incidence of unexpected head movement,SpO2 〈90%,and snoring was significantly increased,and the time when the patients in supine position were turned to prone position was prolonged （P〈0.05）,and no significant difference was found in the incidence of postoperative nausea and vomiting and oculocardiac reflex during the procedure in group Ⅱ （P〉0.05）.Conclusion Mild sedation of MAC （BIS value ≥ 80） provides better efficacy than profound sedation （BIS value 65-80） when used for vitrectomy.

关 键 词：麻醉 监测 生理学 清醒镇静 玻璃体切除术 

分 类 号：R614[医药卫生—麻醉学]