脑电双频指数对阻塞性睡眠呼吸暂停综合征患者经鼻清醒盲探气管插管镇静深度监测

Bispectral index for monitoring sedative depth during conscious blind nasotracheal intubation in patients with obstructive sleep apnea syndrome

目的：探讨脑电双频指数用于监测阻塞性睡眠呼吸暂停综合征患者经鼻清醒盲探气管插管时镇静深度的安全性和有效性。方法：40例Malampati试验Ⅲ~Ⅳ级的阻塞性睡眠呼吸暂停综合征患者,行经典悬雍垂腭咽成形术。插管前给予咪唑安定、芬太尼,至警觉镇静评分为3分时,经鼻腔盲探气管插管,观察用药前后及插管前后心率、平均动脉压、血氧饱和度、脑电双频指数和警觉镇静评分的变化。结果：患者脑电双频指数值均随镇静深度加深而下降,且与镇静评分下降一致;随警觉镇静评分降低,脑电双频指数、心率和平均动脉压均逐渐降低,与镇静前比较差异有统计学意义（P〈0.05）;经鼻腔气管插管后1,3 min脑电双频指数、心率和平均动脉压均上升,与插管前警觉镇静评分3分时比较差异有统计学意义（P〈0.05）;镇静后患者均能耐受气管插管操作,术后随访患者对气管插管过程均无不良回忆。结论：脑电双频指数能准确反映阻塞性睡眠呼吸暂停综合征患者经鼻腔插管时的镇静深度,与警觉镇静评分呈正相关;脑电双频指数值为71~80,警觉镇静评分3分时的镇静深度最适宜行清醒盲探经鼻气管插管。

Objective To investigate the efficacy and safety of bispectral index for monitoring the sedative depth during conscious blind nasotracheal intubation in patients with obstructive sleep apnea syndrome.Methods Forty patients with obstructive sleep apnea syndrome receiving Malampati test Ⅲ to Ⅳ underwent uvulopalatopharyngoplasty.When the score of observer's assessment of alertness/sedation was dropped to three by fentanyl and midazolam,the patients were performed blind nasotracheal intubation.The heart rate,mean arterial pressure,bispectral index,blood oxygen saturation and observer's assessment of alertness/sedation were determined and observed before and after medication,and before and after intubation.Results The values of bispectral index in every patient dropped with the deepening of sedation,and were accorded with the drop of observer's assessment of alertness/sedation,with which the bispectral index,heart rate and mean arterial pressure of all patients decreased gradually,which showed significant differences compared with those before sedation(P<0.05).The bispectral index,heart rate and mean arterial pressure of all patients were higher after nasotracheal intubation(P<0.05).All patients were tolerant to the process of the blind tracheal intubation.Postoperative follow-up survey showed no patient had any bad memories of intubation.Conclusion Bispectral index can show exactly the changes of sedative depth of nasotracheal intubation in patients with obstructive sleep apnea syndrome,and is positively correlated with the observer's assessment of alertness/sedation.It is suitable to perform conscious blind nasotracheal intubation when the score of observer's assessment of alertness/sedation is three and the bispectral index is from 71 to 80.