老年高血压患者脑电双频指数监测下拔管的临床观察

Deep anesthetic extubation guided by BIS in geriatric patients with hypertension

目的通过观察65岁以上老年高血压患者在不同脑电双频指数(BIS)值下拔管的临床指标,确定老年高血压患者合理的拔管时机。方法90例ASAⅠ或Ⅱ级65岁以上高血压患者,术前血压控制在160/100mmHg以下,手术结束后持续输注丙泊酚,并分别维持BIS值在55±5(A组)、75±5(B组)、95±5(C组),达到拔管指征后,拔除气管导管,拔管后即刻停止丙泊酚输注,比较患者ECG、MAP、HR、SpO2、ST段绝对值的变化,术后镇静/警觉(OAA/S)评分、呛咳发生率、舌后坠发生率、拔管知晓率及清醒时间等。结果A组和B组中患者拔管前后MAP、HR、ST段绝对值均无显著变化,但有增高趋势,C组MAP、HR拔管即刻和拔管后5min时及ST段绝对值拔管即刻均明显增加(P<0.05或P<0.01);A组患者口咽通气道使用率明显高于B、C组,清醒时间明显延长(P<0.05或P<0.01),C组患者呛咳率、拔管知晓率明显增高(P<0.01)。结论老年高血压患者较合理的拔管时机为BIS值75±5左右。

Objective ,To determine the value of BIS as a guide for anesthetic extubation in elder patients with hypertension. Methods Ninety patients aged above 65 with ASA Ⅰ or Ⅱwhose BP controlled under 160/110 mmHg were randomized divided into three groups with 30 cases each, according to the BIS value of 55 ± 5 （group A）, 75±5 （group B）, and 95 ± 5 （group C） at extubation. All patients were given propofol after operation, and extubated when the respiration recovered surely, then the changes of ECG, BP, HR, SpO2, ST, cough reaction, recovery time and awareness of extubation were observed. Results The changes of MAP, HR, ST before and after extubation in group A is-higher than that of group B, but there was no significant difference. The changes of MAP, HR and ST segment were increased significantly at extubation and 5 min after extubation in group C（P〈0.05 or P〈0.01）. The ratio of airway use in group A is higher than that of group B and group C,and the patients in group A need more time to recovery（P〈0.05 or P〈0.01）. The cough reaction ratio and awareness of extubation in group C is significantly rise（P〈0.01）. Conclusion The BIS value of 75± 5 could be a proper indication of tracheal extubation under deep sedation in elder patients with hypertension.