麻醉意识深度指数在老年男性前列腺电切手术中的临床应用  

Clinical Application of CSI to Monitor the Depth of Anesthesia in Transurethral Prostatectomy of Elderly Patients

作　　者：谢颖 袁卫国 李林佶 冯麟 李顺洪 Xie Ying Yuan Weiguo Li Linjie Feng Lin LI Shunhong.(Nanchong Central Hospital, Nanchong 637000, Chin)

机构地区：[1]南充市中心医院麻醉科,南充637000

出　　处：《成都医学院学报》2017年第5期611-614,共4页Journal of Chengdu Medical College

摘　　要：目的探讨麻醉意识深度指数(cerebral state index,CSI)变化在老年男性前列腺电切手术中监测麻醉深度的应用价值。方法选取2016年1月至2017年3月在四川省南充市中心医院全麻下行前列腺电切手术老年患者120例,年龄65~85岁,美国麻醉医师协会分级标准(American society of anesthesiologists,ASA)Ⅰ~Ⅲ级。静脉诱导,插入SLIPATM喉罩,术中予以间歇正压通气(intermittent positive pressure ventilation,IPPV),吸入七氟醚,间断推注顺阿曲库铵维持肌松,靶控输注(target controlled infusion,TCI)模式静脉泵注瑞芬太尼。采用随机数字表法,分为CSI组和对照组,每组各60例。记录患者年龄、体质量、文化水平、ASA分级、手术时间、顺阿曲库铵和瑞芬太尼用量,以及麻醉诱导前(T0)、诱导后(T1)、插入喉罩后即刻(T2)和苏醒时(T3)的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)和CSI值。记录麻醉苏醒时间(停用七氟烷至能听从指令睁眼时)和拔除喉罩时间(停用七氟烷至拔除喉罩时)。应用简易精神状态量表(mini-mental state examination,MMSE)分别于麻醉前和拔除喉罩后1、6、24、48h评价患者认知功能。结果在麻醉维持期,CSI组患者血流动力学更平稳,差异有统计学意义(P<0.05);CSI组与对照组比较,在睁眼时间和拔除喉罩时间上均明显缩短,差异有统计学意义(P<0.05);MMSE评分与对照组比较,CSI组在麻醉前及拔除喉罩后48h评分,差异无统计学意义(P>0.05),而在拔除喉罩后1、6、24h评分均明显增高,差异有统计学意义(P<0.05)。结论在老年男性前列腺电切手术中,通过CSI为麻醉深度监测提供量化指标,能较为满意地维持患者血流动力学平稳,降低老年患者术后出现认知功能障碍(postoperative cognitive dysfunction,POCD)的概率,增加老年患者麻醉的安全性。Objective To explore the application values of cerebral state index （CSI） to monitor the depth of anesthesia in transurethral prostatectomy of elderly patients. Methods 120 elderly patients aged from 65 to 85 and having undergone the transurethral prostatectomy in Nanchong Central Hospital from January of 2016 to March of 2017 were selected in the study and they were classified as Grade Ⅰ to Ⅲ according to the criteria of American Society of Anesthesiologists （ASA）. After the induction by intravenous injection, the laryngeal mask of SLIPATM was intubated. The intermittent positive pressure ventilation （IPPV） was given during the operation. Sevoflurane was inhaled, cisatraeurium was injected discontinuously to maintain the muscle relaxation, and the intravenous pumping of remifentanil was administered by the mode of target controlled infusion （TCI）. The parameters were recorded including the patients＂ age, body mass index, educational background, ASA grade, operation time, the dosages of cisatracurium and remifentanil, and the levels of mean arterial pressure （MAP）, heart rate （HR）, and CSI before and after the anesthesia induction （TO and T1）, after the intuhation of the laryngeal mask （T2） and at the awaking time （T3） respectively. The anesthesia time （the duration from the time of stopping giving sevoflurane to the time when the patients can follow the direction to open eyes） and the extubation time （the duration from the time of stopping giving sevoflurane to the time when the laryngeal mask was pulled out） were also recorded, The Mini- mental State Examination （MMSE） was used to assess the patients＂ cognitive function 1, 6, 24 and 48 hours after extubation respectively. Results During anesthesia maintenance, the hemodynamics was more stable and the anesthesia time and extubation time were shorter in the CSI group than in the control group, and the differences were statistically different （P〈0.05）. The MMSE results showed the scores before anesthes

关 键 词：老年患者 前列腺电切 麻醉意识深度指数 麻醉深度 

分 类 号：R614.2[医药卫生—麻醉学]