基于视觉分析脑电图的镇静管理对体外循环心脏瓣膜置换术患者术后谵妄的影响  

Effect of sedation management based on visual analysis of electroencephalography on postoperative delirium in patients undergoing cardiac valve replacement with cardiopulmonary bypass

作　　者：刘伟[1] 张雷[1] 吴昊 顾尔伟[1] 陈立建[1] Liu Wei;Zhang Lei;Wu Hao;Gu Erwei;Chen Lijian(Department of Anesthesiology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院麻醉科,合肥230022

出　　处：《中华麻醉学杂志》2020年第2期136-139,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价基于视觉分析脑电图的镇静管理对体外循环(CPB)心脏瓣膜置换术患者术后谵妄的影响。方法选择择期CPB心脏瓣膜置换术患者80例,年龄≥18岁,ASA分级Ⅲ或Ⅳ级,NYHA分级Ⅱ-Ⅳ级,采用随机数字表法分为2组(n=40):视觉分析脑电图指导镇静管理组(A组)和BIS指导镇静管理组(B组)。A组通过调节丙泊酚血浆靶浓度,维持麻醉深度于C或D级;B组通过调节丙泊酚血浆靶浓度,维持BIS值40~60。记录CPB期间丙泊酚用量及术中总用量、术中血管活性药物用量和动脉血气指标。术后第1-7天采用CAM-ICU量表评定术后谵妄发生情况。记录气管拔管时间、ICU驻留时间、术后住院时间及术中知晓发生情况。结果与B组比较,A组术后住院时间缩短,术后谵妄发生率较低(P<0.05),动脉血气指标、丙泊酚用量、血管活性药物用量、气管拔管时间、ICU驻留时间比较差异无统计学意义(P>0.05)。2组均未见术中知晓发生。结论基于视觉分析脑电图的镇静管理有助于降低CPB心脏瓣膜置换术患者术后谵妄的发生。Objective To evaluate the effect of sedation management based on visual analysis of electroencephalography(EEG)on postoperative delirium in patients undergoing cardiac valve replacement with cardiopulmonary bypass(CPB).Methods Eighty patients,aged≥18 yr,of American Society of Anesthesiologists physical statusⅢorⅣ,with New York Heart AssociationⅡ-Ⅳ,scheduled for elective cardiac valve replacement with CPB,were randomly divided into visual analysis of EEG-guided sedation management group(group A,n=40)and BIS-guided sedation management group(group B,n=40).The target plasma concentration of propofol was adjusted to maintain the depth of anaesthesia at grade C or grade D in group A and BIS value at 40-60 in group B.Propofol consumption during CPB and total consumption of propofol during surgery,requirement for vasoactive agents during surgery,and parameters of intraoperative arterial blood gas analysis were recorded.Postoperative delirium was evaluated using Confusion Assessment Method for the Intensive Care Unit(ICU)at 1-7 days after surgery.Extubation time,length of ICU stay,length of postoperative hospital stay and intraoperative awareness were also recorded.Results Compared with group B,the length of postoperative hospital stay was significantly shortened,the incidence of postoperative delirium was decreased,and no significant change was found in the parameters of arterial blood gas analysis,propofol consumption,requirement for vasoactive agents,extubation time,or length of postoperative ICU stay in group A(P<0.05).No intraoperative awareness occurred in both groups.Conclusion Sedation management based on visual analysis of EEG is helpful in decreasing the development of postoperative delirium in the patients undergoing cardiac valve replacement with CPB.

关 键 词：脑电描记术 苏醒谵妄 心肺转流术 

分 类 号：R614[医药卫生—麻醉学] R654.2[医药卫生—外科学]