唤醒实验期间脑电双频指数与术后外显回忆

EEG BEPECTRAL INDICES DURING ESTRAOPERATIVE WAKE-UP TEST AND POSTOPERATIVE RECALL

为探讨脑电双频指数(BIS)行脊柱侧弯手术在唤醒实验期间的监测价值,将34例青少年患者随机分成两组,Ⅰ组(氨氟醚组)19例,麻醉用药为小剂量氨氟醚、笑气、芬太尼和咪唑安定;Ⅱ组(非氨氟醚组)15例,麻醉用药为笑气、芬太尼和咪唑安定,两组均行控制性降压。术中记录患者在唤醒实验前、对指令有反应时、再次加深麻醉后的BIS、MAP和HR。当患者对指令有反应时,让患者记住一种特殊颜色。术后第2天访视患者,了解患者对颜色和术中事件有无外显回忆。34例患者共进行37次唤醒实验,结果显示两组患者对指令有反应时BIS、MAP均明显增高(P<0.001),HR也有增高(P<0.01),在加深麻醉后BIS明显下降(P<0.01)。没有回忆起术中疼痛,有1例患者能回忆起唤醒实验但不能回忆起颜色,5例能回忆起特殊的颜色。表明在唤醒实验时使用BIS预测患者对指令的反应时一个比较好的临床监测手段,尤其是当术中控制性降压使麻醉医师难以依靠血流动力学反应来判断麻醉深度时。

In order to explore the monitoring value of EEC bispectral indices (BIS) during the wake-up test in scoliosis surgery, 34 juvenile cases were randomly divided into Group One (19 cases) and Croup Two (15 cases), which were anesthetized with small doses of enflurane, nitrous oxide , fentanyl and midazolam and with nitrous oxide, fentanyl and midazolam, respectively; intraoperative controlled hypotension was used for both groups; the BIS, mean arterial pressure (MAP) and heart rate (HR) were recorded before the wake-up test and after the deepened reanesthesia in the patient's reaction to the command. When they reacted to the command, the patients were told to remember a specific color. On the second postoperative day, the patients were interviewed as to find out whether they recalled the color and the intraoperative evens. Thirty-seven wake-up tests were made on 34 cases. The results showed that BIS and MAP of both groups ascended significantly when the patients reacted to the command (P < 0.001) and HR ascended (P < 0.01), too but BIS descent obviously after the deepened anesthesia (P < 0.01) with no the intraoperative pains recall. One case recalled the wake-up test but no color, and five cases recalled the specific color, suggesting that in the wake-up test, BIS used to predict the patient's reaction to the command may be regarded as a good clinical monitoring means, especially when the intraoperative controlled hypotension brings the anesthetist difficulty to judge the anesthesia depth with the hemodynamic responses.