BIS监测减轻全麻下鼻内镜手术患者围术期应激反应的作用及机制研究  

Effectiveness of bispectral index monitoring for patients undergoing endoscopic sinus surgery

作　　者：毛卫亮 潘学文[1] MAO Weiliang;PAN Xuewen(Department of Anesthesiology,Huzhou First People's Hospital,Huzhou 313000,China)

机构地区：[1]湖州市第一人民医院麻醉科,313000

出　　处：《浙江医学》2021年第14期1568-1571,共4页Zhejiang Medical Journal

摘　　要：目的探讨脑电双频谱指数(BIS)减轻全麻下鼻内镜手术患者围术期应激反应的作用及机制。方法将2018年3月至2019年3月湖州市第一人民医院行鼻内镜手术治疗的102例患者按照随机数字表法分为观察组及对照组,各51例。两组患者均行全身麻醉,对照组采用常规麻醉方案,并予以常规监护措施。观察组在对照组的基础上进行BIS监测。观察并比较两组患者一般资料、手术前后血皮质醇、血管紧张素Ⅱ、围术期血褪黑素水平、苏醒期Ricker镇静-躁动评分(SAS)评分。结果两组患者手术时间、出血量、补液量比较差异均无统计学意义(均P>0.05),观察组患者苏醒时间明显短于对照组(P<0.05);两组患者手术前后皮质醇、血管紧张素Ⅱ水平比较差异均有统计学意义(均P<0.05),术毕两组患者皮质醇、血管紧张素II水平均升高(均P<0.05),拔管后较术毕显著降低(P<0.05),对照组患者术毕、拔管后3 h皮质醇、血管紧张素II水平均高于观察组(均P<0.05);两组患者手术前后褪黑素水平比较差异有统计学意义(P<0.05),拔管后1 h两组患者褪黑素水平较术毕时降低(P<0.05),观察组患者术毕、拔管后1 h褪黑素水平高于对照组(均P<0.05);两组患者拔管时SAS评分较睁眼时均升高(均P<0.05),拔管后30 min SAS评分较拔管时均降低(均P<0.05),观察组患者睁眼时、拔管时SAS评分均低于对照组(均P<0.05)。结论BIS监测能有效减轻全麻下鼻内镜手术患者的应激反应,减少术后躁动的发生率,可能与减少对褪黑素分泌的抑制有关。Objective To analyze the effectiveness of bispectral index(BIS)for patients undergoing endoscopic sinus surgery.Methods One hundred and two patients who underwent endoscopic surgery in our hospital from March 2018 to March 2019 were randomly divided into study group(51 cases)and control group(51 cases).The general anesthesia was performed for both groups,patients in the control group received routine anesthesia program and routine monitoring measures,while patients in study group were monitored with BIS of EEG on the basis of the control group.The age,gender,body weight,operation time,intraoperative blood loss,fluid replenishment of the two groups were observed and recorded.The scores of cortisol,angiotension II,perioperative melatonin,and wake-up Ricker sedation agitation score(SAS)were measured before and after operation.Results There were no significant differences in age,gender,body weight,operation time,intraoperative blood loss and fluid replenishment between the two groups(P>0.05).The recovery time of patients in the study group was significantly shorter than that in the control group(P<0.05).Compared with preoperative levels,the cortisol and angiotension Ⅱ were significantly increased in the two groups after operation(P<0.05).After extubation,the levels of cortisol and angiotension Ⅱ in the control group were significantly higher than those in the study group(P<0.05).There was no significant difference in melatonin concentration between the two groups before operation(P>0.05).With the progress of time,melatonin concentration of the two groups decreased significantly,and the melatonin concentration of the two groups at 1 h after extubation was significantly lower than that at the end of operation(P<0.05).The concentration of melatonin at 1 h after extubation was significantly higher than that in the control group(P<0.05).The SAS scores of the two groups were significantly increased at the time of extubation(P<0.05),and the SAS scores of the study group were significantly lower than those of the control

关 键 词：躁动 应激 褪黑素 脑电双频谱指数 

分 类 号：R614[医药卫生—麻醉学]