脑电双频谱指数监测依托咪酯在60岁以上患者无痛胃镜检查的临床观察

The usage of etomidate in over sixty-years-old patients' painless induced gastroscopy under the direction of bispectral index

目的观察脑电双频谱指数(BIS)监测依托咪酯用于60岁以上患者无痛胃镜检查的临床意义。方法将40例全身麻醉下行胃镜检查的60岁以上患者随机分为两组,缓慢推注芬太尼0.5～0.7μg/kg,2 min后Ⅰ组静脉注射依托咪酯0.15～0.30 mg/kg;Ⅱ组静脉注射依托咪酯直至患者BIS值降至40～60时停止给药并记录所用药量。术中Ⅰ组如出现呛咳、肢体活动,Ⅱ组当BIS值达到60或出现呛咳、肢体活动时记录当时BIS值,并追加依托咪酯(4 mg/次)。观察各时点的BIS值、是否出现呛咳体动反应、用药量、清醒时间等指标。结果两组患者的总用药量比较差异无统计学意义(P>0.05),术中平均BIS值Ⅱ组低于Ⅰ组(P<0.01),应答及清醒时间Ⅱ组比Ⅰ组缩短(P<0.01),呛咳及体动率Ⅱ组较Ⅰ组少(P<0.05)。结论脑电双频谱指数监测可指导60岁以上患者无痛胃镜检查中依托咪酯用量,维持适当的麻醉深度,有助于减少呛咳体动反应,使患者及时清醒。术中BIS值维持40～60的范围较为合适。

Objective To observe the significance of the bispectral index（BIS） in directing the usage of etomidate for over sixty-years-old patients in painless induced gastroscopy.Methods Forty sixty-years-old patients undergoing painless induced gastroscopy using an etomidate anesthetic technique were divided into two groups randomly： Firstly both groups were induced with fantenyl 0.5-0.7 μg/kg slowly,then after two minutes,groupⅠreceived etomidate for 0.15-0.30 mg/kg,group Ⅱreceived etomidate dose depending on target BIS values： 40-60 for it.More drug dose of 4 mg would be given if cough and movement were observed in both groups or BIS beyonded the target value in group Ⅱ and the BIS at that time was recorded.The BIS values at regular intervals,the total drug dosage,the cough and movement during the operation,and the time of consciousness were observed.Results There was no significant difference（P0.05） in the total drug dosage between the two groups,but the average BIS values during the operations（P0.01）,the time of consciousness（P0.01） and the rate of cough and movement（P0.05） were lower in group Ⅱ than that in group Ⅰ.Conclusion BIS can be used to direct the usage of etomidate and maintain the perfect depth of the anaesthesia during painless induced gastroscopy,to reduce the cough and movement and the time of consciousness for over sixty-years-old patients.To maintain BIS value between 40-60 is suggested.