脑电双频指数指导喉罩置入时机的可行性

Role of bispectral index in choosing the opportunity of inserting laryngeal mask airway

目的观察静脉注射丙泊酚、芬太尼行麻醉诱导后,根据脑电双频指数(BIS)指导喉罩置入时机的可行性。方法选择择期于静脉全身麻醉下行乳房肿块区段切除手术的患者60例,经静脉输液泵恒速注射芬太尼2.5μg/kg、丙泊酚1mg·kg-1·min-1行麻醉诱导。根据置管前即刻的BIS值将患者分入BIS值46～60组、BIS值30～45组、BIS值<30组,每组20例。观察患者置管条件和血流动力学指标的变化。结果 3组在置管前、置管后的BIS值均较同组麻醉诱导前显著降低(P值均<0.05),置管后的BIS值均较同组置管前显著升高(P值均<0.05)。3组在置管前的血压、心率(HR)均较同组麻醉诱导前显著降低(P值均<0.01),BIS值<30组在置管前的血压、HR均显著低于BIS值46～60组和BIS值30～45组同时间(P值均<0.01);BIS值46～60组在置管后的血压、HR均显著高于BIS值30～45组和BIS值<30组同时间(P值均<0.05),BIS值<30组在置管后的血压、HR均显著低于BIS值30～45组同时间(P值<0.05)。BIS值46～60组在置管即刻出现麻醉过浅症状的构成比显著高于BIS值30～45组和BIS值<30组(P值均<0.05)。BIS值30～45组和BIS值<30组的患者置管满意度均为95%(19/20),显著高于BIS值46～60组的65%(13/20,P值均<0.01)。结论 BIS值为30～45时,患者的置管条件较好且血流动力学较平稳,此时置管最为合适。

Objective To investigate the choosing of opportunity of inserting laryngeal mask airway （LMA） after venous anesthesia with propofol and fentanyl according to bispectral index （BIS）. Methods Sixty patients scheduled for breast lumpectomy under general anesthesia were enrolled in the study. They were divided into three groups and there were 20 patients in each group. BIS was 46- 60 in group A, 30- 45 in group B, and 30 in group C before intubation. Anesthesia was induced by fentanyl 2.5 μg/kg and propofol 1·kg^-1·min^-1. Hemodynamics change and intubation condition were observed. Results Compared with that before anesthesia induction, BIS were decreased significantly before and after intubation in all patients （all P〈0.05）. BIS after intubation were significantly higher than before intubation （all P^0.05）. Blood pressure and heart rate before intubation were significantly lower than those before induction of anesthesia in all patients （all P〈0.01）. Before intubation, blood pressure and heart rate in group C were significantly lower than those in the other two groups （all P〈0.01）. After intubation, blood pressure and heart rate in group A were significantly higher than those in the other two groups （all P〈0.05） . blood pressure and heart rate in group C were significantly lower than those in group B （all P〈0.05）. The incidence of inadequate anesthesia in group A was significantly higher than that in the other two groups when the catheter was inserted （all P〈0.05）. The degree of patient＇s satisfaction in group A （13/20） was significantly lower than that in group B and C （both 19/20, both P 〈0.01 ）. Conclusion The optimum time for intubation is when BIS is between 30 and 45 when the patients have a stable hemodynamic condition.