体外循环低温条件下冠状动脉旁路移植术中IOC2镇痛监测的临床应用评价  

Clinical evaluation of IOC2 analgesia monitoring under hypothermic cardiopulmonary bypass during coronary artery bypass grafting

作　　者：刘贝 聂超然 田肇隆[1] 张敏[1] 王天龙[1] 王小华[1] Liu Bei;Nie Chaoran;Tian Zhaolong;Zhang Ming;Wang Tianlong;Wang Xiaohua(Department of Anesthesiology and Operating Theater,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院麻醉手术科,北京100053

出　　处：《北京医学》2018年第6期517-519,共3页Beijing Medical Journal

摘　　要：目的探讨低温体外循环条件下伤害敏感指数(index of consciousness 2,IOC2)和低温的关系,为体外循环心脏外科手术条件下麻醉深度的监测提供思路。方法选择39例拟行体外循环低温条件下冠状动脉旁路移植术的患者,术中监测生命体征、脑电意识指数(index of consciousness 1,IOC1)、IOC2、BIS值及体温;比较在体外循环前、体外循环期间、体外循环后不同时点IOC1、IOC2、BIS值和体温的波动和变化趋势及其相关性。结果在体外循环期5、10、15、20 min间,与体外循环前5、10、15 min及体外循环后5、10、15 min相比,体温与IOC2均显著降低,且变化有相同趋势(P<0.01);BIS值并不随体温的变化而变化,与体温的相关性极弱;而IOC2与体温呈正相关性(R2=0.71,P<0.01)。结论低温能增加镇痛深度,IOC2与体温的变化呈正相关,且有效反映镇痛强度。IOC2监测是冠状动脉旁路移植术体外循环期间术中监测镇痛的重要手段,能够指导体外循环期间的麻醉和镇痛深度,具有广泛的临床应用前景。Objective To investigate the relationship between index of consciousness 2 （ICO2） and hypothermia under hypothermic cardiopulmonary bypass （CPB）, and provide new ideas for monitoring the depth of anesthesia in patients undergoing coronary artery bypass grafting （CABG）. Methods Thirty-nine patients with coronary arteriosclerosis for CABG under hypothermic CPB were selected. Routine vital signs, IOC, BIS and temperature during operation were monitored. The change trend of IOC2 and temperature and their correlation were observed in different timepoint at basic state, pre-CPB, during CPB and post-CPB. Results Both temperature and IOC2 had significant descending trend at 5 min, 10 min, 15 min, 20 min after the CPB starting compared to the same time points of pre-CPB and post-CPB （P 〈 0.01）, which indicated that ICO2 and temperature were interrelated tightly. However, the data of BIS didn＇ t have the same presentation. Condusion Hypothermia can increase the depth of analgesia, IOC2 is positively correlated with the change of temperature. In addition, IOC2 can reflect the intensity of analgesia, and it is an important means of intraoperative monitoring during CABG.

关 键 词：冠状动脉旁路移植术 体外循环 低温 IOC2 镇痛 

分 类 号：R614[医药卫生—麻醉学]