肌松闭环注射系统联合听觉诱发电位指数在老年人全身麻醉中的应用研究

The application research in the close-loop muscle relaxant injection system combined with auditory evoked potentials index for monitoring in elderly patients during general anesthesia

目的观察肌松闭环注射系统（CLMRIS）联合听觉诱发电位指数监测在老年人全身麻醉中的临床效果及安全性。方法选取我院2012年2月至2012年10月期间收治的美国麻醉医师协会（ASA）I～Ⅱ级腹部手术麻醉老年患者100例。随机将其分为两组，经验组和CLMRIS组，每组50例。经验组根据麻醉师临床经验判断用药实施麻醉；CLMRIS组依据肌松闭环注射系统指导肌松药使用。在人室、诱导即刻、插管、切皮、进腹、探查、关腹、缝皮、意识恢复、气管拔管、出室11个时间点（T0～T10），观察记录听觉诱发电位指数及各项生命指标；记录肌松药总量、诱导苏醒时间、术中体动反应率；不良反应。结果所有患者生命体征均平稳，经验组T8～T10各时点RR最低（P〈0．05）。组内与T0～T1比较，T8～T10各时点平均动脉压、心率未见升高（P〉0．05）。CLMRIS组插管时间为（268±30．4）min、拔管时间为（14±6．4）min，经验组插管时间为（172±23．7）min、拔管时间为（18±7．9）min，CLMRIS组均短于经验组（t=3．277，6．341．P〈0．05）；CLMRIS组苏醒时间（8．8±2．9）min较经验组（12．2±4．6）rain时间短（t=3．346，P〈0．05）；两组基础值比较差异无统计学意义（P〉0．05），意识消失时差异明显，CLMRIS组优于经验组。结论肌松闭环注射系统的应用提高了老年人全身麻醉安全性，可减少术后残余肌松的发生率，同时配合听觉诱发电位监测麻醉深度，防止及减少了术中知晓的发生率，使老年人全身麻醉可控性强，麻醉诱导平稳，达到减少麻醉药物达到最佳麻醉效果。

Objective To observe the clinical efficacy and safety of close-loop muscle relaxant injection system （CLMRIS） combined with auditory evoked potentials index for monitoring in elderly patients during general anesthesia. Methods A total of 100 patients undergong abdominal operation with ASA I -Ⅱ anesthesia in our hospital from February 2012 to October 2012 were selected. Patients were randomly divided into 2 groups： the traditional group （n= 50） and the CLMRIS group （n= 50）. The traditional group was anaesthetized according to clinical experience, and the CLMRIS group was used with the muscle relaxant guided by the close-loop muscle relaxant injection system. The auditory evoked potential （AEP） index and the life index were observed, and the dose of muscle relaxant, the time of consciousness recovery, dynamic response rate during operation and the adverse reaction were recorded at the time points at entering the operating room, induction of anesthesia, tracheal intubation, incision, into the abdominal, exploration, closing abdomen, skin suture, consciousness recovery, tracheal extubation, out of room （T0- T10）. Results The vital signs in all patients were stable. The dynamic response rate during operation was lower in the CLMRIS group than in the traditional group at each time points of T0-T10 （all P〈0.05）. There was no increase in mean artery pressure （MAP） and heart rate in groups at the time points of T0-T1 , T0-T10 （all P〉0.05）. The time of tracheal intubation, tracheal extubation and consciousness recovery were shorter in the CLMRISgroup than in the traditional group [（268±30.4） min vs. （172±23.7） min, （14±6.4） min vs. （18 ±7.9） min, （8.8±2.9） min vs. （12.2±4.6） min, respectively, t=3.277, 6.341, 3.346, all P〈 0. 053. There were no significant differences in AEP index between groups at the time of To （P〉 0.05）, but at the time of T1, the AEP index was lower in CLMRIS group than in the traditional group （P〈0.05）. Conclusions The application of close-loop muscle relaxant injection system can improve the safety of general anesthesia in the elderly and reduce the incidence of postoperative residual paralysis. The CLMRIS combined with the auditory evoked potential for monitoring depth of anesthesia can prevent and reduce the incidence of intraoperative awareness, has a strong controllability in general anesthesia with smooth induction, and can reduce the dose of anesthetic drugs to achieve the best anesthetic effect.