伤害指数联合脑电双频指数监测下全身麻醉在腹腔镜结直肠癌根治术中的应用  

Application of general anesthesia under nociception index combined with BIS monitoring in laparoscopic radical resection of colorectal cancer

作　　者：邓伟[1] 彭丹 胡海军 张静[1] 余树春[1] 黄松[1] DENG Wei;PENG Dan;HU Haijun;ZHANG Jing;YU Shuchun;HUANG Song(Department of Anesthesiology,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,Jiangxi,China)

机构地区：[1]南昌大学第二附属医院麻醉科,江西南昌330006

出　　处：《实用医学杂志》2024年第24期3476-3481,共6页The Journal of Practical Medicine

基　　金：国家自然科学基金资助项目(编号:82160371);江西省卫生健康委科技计划(编号:202210595)。

摘　　要：目的评价伤害指数(nociception index,NOX)联合脑电双频指数(bispectral index,BIS)监测在腹腔镜结直肠癌根治术的麻醉管理。方法选择全凭静脉麻醉下行腹腔镜结直肠择期手术的患者80例,性别不限、50~80岁、ASAⅠ-Ⅱ级。随机分为两组:NOX联合BIS组(N组)和单独BIS组(C组),每组40例。N组维持合适的镇痛深度(NOX值为30~50),合适的镇静深度(BIS值为40~60);C组维持合适的镇静深度(BIS 40~60),用不透光卡片遮挡隐藏NOX,凭麻醉医师经验调节合适的镇痛深度。主要观察指标为术中瑞芬太尼用量,次要观察指标包括术中丙泊酚和顺阿曲库铵用量、血管活性药使用情况,麻醉苏醒和拔管时间,术后NRS疼痛评分和舒芬太尼用量,术后苏醒期躁动、术后恶心呕吐、头晕和术中知晓等不良反应情况。结果N组患者术中瑞芬太尼用量明显少于C组(P<0.05)。N组术后苏醒和拔管时间明显早于C组(P<0.05),N组术中血管活性药使用例数、术后苏醒期躁动、术后恶心呕吐和头晕发生率明显少于C组(P<0.05),两组患者术中丙泊酚和顺阿曲库铵用量、术中知晓发生率差异无统计学意义(P>0.05)。N组患者术后2、4、6、24 h NRS评分明显低于C组(P<0.05)。N组患者术后0~12 h、12~24 h舒芬太尼消耗量明显少于C组(P<0.05),两组患者术后24~48 h舒芬太尼消耗量差异无统计学意义(P>0.05)。结论与单独BIS监测相比,采用NOX联合BIS监测能维持术中血流动力学相对稳定,减少全麻药物用量,加快术后麻醉苏醒,改善麻醉苏醒质量,并减轻术后急性疼痛,有利于患者术后康复。Objective To evaluate the Nociception Index(NOX)combined with Bispectral Index(BIS)monitoring of anesthesia management during laparoscopic radical resection of colorectal cancer.Methods A total of 80 patients,regardless of gender,aged 50 to 80 years old,and ASA gradeⅠorⅡ,chose to undergo elective laparoscopic colorectal surgery under total intravenous anesthesia.They were randomly divided into two groups:NOX combined with BIS group(Group N)and BIS alone group(Group C),with 40 cases in each group.Group N maintains an appropriate analgesia depth(NOX value is 30~50)and sedation depth(BIS value is 40~60),and group C maintains an appropriate sedation depth(BIS 40~60)and is covered with opaque cards Hide NOX and adjust the appropriate analgesia depth based on the experience of the anesthesiologist.The main observational indicator is the intraoperative remifentanil dosage,and the secondary observational indicators include the intraoperative propofol and cisatracurium dosage,vasoactive drug use,anesthesia recovery and extubation time,postoperative NRS pain score and sufen.The dosage of Titanyl,adverse reactions such as agitation in the postoperative recovery period,postoperative nausea and vomiting,dizziness,and intraoperative awareness.Results The amount of remifentanil used during the operation in group N was significantly less than that in group C(P<0.05).The time of postoperative recovery and extubation in group N was significantly earlier than that in group C(P<0.05).The number of cases of intraoperative use of vasoactive drugs,the incidence of postoperative agitation during recovery,postoperative nausea and vomiting,and dizziness in group N were significantly lower than those in group C(P<0.05).There were no significant differences in the amount of propofol and cis-atracurium used during surgery and the incidence of awareness between the two groups(P>0.05).The NRS scores of patients in group N were significantly lower than those in group C at 2,4,6,and 24 hours after surgery(P<0.05),while there was no significa

关 键 词：伤害指数 脑电双频指数 全身麻醉 结直肠癌 术后康复 

分 类 号：R614[医药卫生—麻醉学]