脑电双频指数监测在脑出血伴轻中度意识障碍患者丙泊酚全麻诱导中的应用  

Application of bispectral index monitoring in propofol induction of general anesthesia for patients with cerebral hemorrhage and mild to moderate disturbance of consciousness

作　　者：曹露 李红 母国 余璇[1] 郑业英[1] 缪冬梅[1] CAO Lu;LI Hong;MU Guo;YU Xuan;ZHENG Ye-ying;MIAO Dong-mei(Department of Anesthesiology,Zigong Fourth People's Hospital,Zigong 643000,China;Department of Anesthesiology,363 Hospital,Chengdu 643041,China)

机构地区：[1]四川省自贡市第四人民医院麻醉科,四川自贡643000 [2]三六三医院麻醉科,四川成都610041

出　　处：《实用医院临床杂志》2022年第6期42-45,共4页Practical Journal of Clinical Medicine

基　　金：自贡市重点科技计划项目(编号:2019YLSF07;2019YLSF08)。

摘　　要：目的 研究脑电双频指数(BIS)监测在脑出血伴轻中度意识障碍的手术患者中丙泊酚全麻诱导的指导意义。方法 拟在全麻下行开颅手术的43例脑出血患者,GCS评分在8~15分,按随机数字表法分为B组(BIS监测下诱导组)21例和G组(按传统经验诱导组)22例。比较两组患者麻醉诱导过程中丙泊酚的使用量以及在诱导前(T_(0))、丙泊酚推注完即刻(T_(1))、气管插管即刻(T_(2))、插管后1min(T_(3))的BIS值、平均动脉压(MAP)、心率(HR)及血液中皮质醇、促肾上腺皮质激素(ACTH)浓度,同时记录BIS<40、心动过缓(HR≤60次/分)、心动过速(HR≥100次/分)、平均动脉压波动超过基础血压20%等不良事件发生率和血管活性药物使用情况。结果 B组的丙泊酚用量明显少于G组,BIS值明显高于G组(P<0.05);T_(1)时,两组患者的MAP均低于T0(P<0.05),且B组高于G组(P<0.05);B组T_(1)~T_(3)的HR均低于G组,低血压、低BIS等不良反应发生率少于G组(P<0.05)。结论 BIS监测应用于轻中度意识障碍的脑出血患者的麻醉诱导,可明显减少丙泊酚的用量,降低麻醉诱导期低BIS和低血压的发生率,麻醉诱导过程更平稳安全。Objective To investigate the guiding significance of bispectral index(BIS)monitoring for induction of propofol anesthesia in patients with cerebral hemorrhage complicated with mild to moderate disturbance of consciousness.Methods Forty-three patients with intracerebral hemorrhage with GCS score of 8~15,who accepted craniotomy under general anesthesia(GA)were randomly divided into a group B(BIS monitoring induction group,n=21)and a group G(traditional experience induction group,n=22)according to the random number table.The total propofol dosage for the induction of GA was recorded.BIS,mean arterial pressure(MAP),heart rate(HR),concentrations of cortisol and ACTH were compared between the two groups before anesthesia induction(T_(0)),after propofol injection(T_(1)),immediately after endotracheal intubation(T_(2))and 1 min after intubation(T_(3)).Also,the incidence of adverse events such as BIS<40,bradycardia(HR≤60 times/min),tachycardia(HR≥100 times/min),and MAP fluctuation exceeding 20%of basal blood pressure as well as the use of vasoactive drugs during induction of anesthesia were recorded. Results The dosage of propofol in the group B was significantly lower than that in the group G(P<0.05),and BIS value in the group B was significantly higher than that in the group G(P<0.05).At T_(1),the MAP of both groups was lower than that at T0(P<0.05),but the MAP of the group G was lower than that of the group B(P<0.05).HR in the group B was lower than that in the group G at T1 to T3(P<0.05).The incidence of adverse reactions such as hypotension and BIS<40 in the group B was lower than that in the group G(P<0.05).Conclusions BIS monitoring can reduce the dosage of propofol,decrease the incidence of low BIS and hypotension during anesthesia induction,and make the induction process more stable and safe.

关 键 词：脑电双频指数 丙泊酚 麻醉诱导 脑出血 

分 类 号：R614.2[医药卫生—麻醉学] R743.3[医药卫生—外科学]