基于意识指数监测指导老年患者胆囊切除术麻醉相关外周血管阻力指数变化的临床研究  

Clinical study on systemic vascular resistance index changes in anesthesia for elderly patients undergoing cholecystectomy guided by index of consciousness monitoring

作　　者：阙敏慧 曹姗 冯鲲鹏[1] 苗芳芳[1] 王天龙[1] Kan Minhui;Cao Shan;Feng Kunpeng;Miao Fangfang;Wang Tianlong(Department of Anesthesiology,Xuanwu Hospital,Capital Medical University,National Center for Clinical Medical Research on Geriatric Diseases,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院麻醉科,国家老年疾病临床医学研究中心,北京100053

出　　处：《国际麻醉学与复苏杂志》2025年第3期241-246,共6页International Journal of Anesthesiology and Resuscitation

基　　金：科技部国家医学研究中心后补助经费(303-01-001-0272-03)。

摘　　要：目的探讨基于意识指数(IoC)监测指导老年患者腹腔镜下胆囊切除术的麻醉管理对外周血管阻力指数(SVRI)的影响。方法选取60岁以上择期行腹腔镜下胆囊切除术的老年患者60例,采用随机数字表法分为两组(每组30例):脑电双频指数(BIS)监测指导组(C组)和IoC监测指导组(T组)。C组患者在常规BIS监测指导下实施麻醉管理,T组患者采用IoC监测指导麻醉管理。比较两组患者一般资料及术中用药情况(丙泊酚、瑞芬太尼、去甲肾上腺素、麻黄素用量及麻黄素使用率),诱导前即刻(T0)、插管5 min(T1)、切皮即刻(T2)、气腹5 min(T3)、头高足低并向左侧倾斜15°体位即刻(T4)、牵拉胆囊即刻(T5)、停气腹5 min(T6)、恢复床位即刻(T7)、缝皮即刻(T8)、拔管前即刻(T9)、拔管后5 min(T10)时SVRI、SVRI变化率(SVRI ROC),术后苏醒质量(自主呼吸恢复时间、呼之睁眼时间、呼之握拳时间、拔管时间、出室时间),拔管后切口痛和内脏痛的视觉模拟评分法(VAS)评分,术后恶心呕吐(PONV)发生率。结果与C组比较,T组T2、T3、T4时SVRI较低(均P<0.05),T1、T3时SVRI ROC<-50%的病例数较少(均P<0.05),T4时SVRI ROC<-30%的病例数较少(P<0.05),T1、T2时-30%≤SVRI ROC<-10%的病例数较多(均P<0.05),T3时-10%≤SVRI ROC<0的病例数较多(P<0.05),T4时-10%≤SVRI ROC<10%的病例数较多(P<0.05),T8时-20%≤SVRI ROC<-10%的病例数较多(P<0.05);与T0时比较,两组患者T2、T3时SVRI升高(均P<0.05)。与C组比较,T组麻黄素用量较少(P<0.05),呼之睁眼时间、呼之握拳时间及拔管时间较长(均P<0.05),拔管后内脏痛VAS评分和PONV发生率较低(均P<0.05)。其余指标差异无统计学意义(均P>0.05)。结论基于IoC监测指导的麻醉管理SVRI的波动幅度较常规BIS监测指导更趋于稳定,这对于维持老年患者腹腔镜下胆囊切除术麻醉期间血管张力的稳定可能具有更好的指导价值和应用前景。Objective To explore the effect of anesthesia management guided by index of consciousness(IoC)monitoring on the systemic vascular resistance index(SVRI)in elderly patients undergoing laparoscopic cholecystectomy.Methods Sixty elderly patients,aged 60 years or older,who were scheduled for laparoscopic cholecystectomy,were selected.According to the random number table method,they were divided into two groups(n=30):a bispectral index(BIS)monitoring-guided group(group C)and an IoC monitoring-guided group(group T).Group C received anesthesia management guided by conventional BIS monitoring,while group T was managed under IoC monitoring guidance.General information and intraoperative drug usage(propofol,remifentanil,norepinephrine and ephedrine dosages,and ephedrine administration rate)were compared.SVRI and the rate of change of SVRI(SVRI ROC)were measured at the following time points:immediately before induction(T0),5 min post-intubation(T1),immediately after skin incision(T2),5 min post-pneumoperitoneum(T3),immediately after 15°head-up and left-tilt positioning(T4),immediately after gallbladder traction(T5),5 min post-pneumoperitoneum cessation(T6),immediately after restoring bed position(T7),immediately after skin suturing(T8),immediately before extubation(T9),and 5 min post-extubation(T10).Postoperative emergence quality(time to spontaneous breathing recovery,time to eye opening,time to fist clenching,time to extubation,and time to discharge from the room),Visual Analog Scale(VAS)scores for incision pain and visceral pain after extubation,and the incidence of postoperative nausea and vomiting(PONV)were also recorded.Results Compared with group C,group T showed significant decreases in SVRI at T2,T3,and T4(all P<0.05).Group T also presented decreases in the number of cases with an SVRI ROC<-50%at T1 and T3(both P<0.05),decreases in the number of cases with an SVRI ROC<-30%at T4(P<0.05),as well as increases in the number of cases with an SVRI ROC between-30%and-10%at T1 and T2,increases in the number of cases with

关 键 词：意识指数 脑电双频指数 外周血管阻力指数 外周血管阻力指数变化率 老年患者 胆囊切除术 麻醉管理 

分 类 号：R614[医药卫生—麻醉学]