不同脑电双频指数指导七氟醚吸入全麻在老年患者关节脱位手法复位术中的比较

Application of BIS guidrance sevoflurane inhalation anesthesia in treatment elderly joint dislocation undergoing manipulative reduction

目的比较不同脑电双频指数（BIS）指导七氟醚吸入全麻在老年患者关节脱位手法复位术中的麻醉效果及安全性。方法老年关节脱位患者48例，ASAⅠ或Ⅱ级，男28例，女20例，年龄65-85岁。随机分为三组，A组：55≤BIS％60，B组：50≤BIS〈55，C组：45≤BIS％50。建立静脉通路后吸入8％七氟醚，调节七氟醚浓度使BIS值处于相应的范围。记录麻醉前、复位前和复位时三组患者的MAP、HR，记录麻醉效果和苏醒时间。记录呼吸抑制和苏醒期躁动、恶心呕吐等发生情况。结果与麻醉前比较，复位前C组MAP明显降低，HR明显减慢（P〈0.05）。与复位前比较，复位时A组患者HR明显增快（P〈0.05）。与C组比较，A、B组患者的苏醒时间明显缩短（P〈0．05）。A组患者的麻醉效果优良率明显低于B、C两组（P〈0.05）。C组呼吸抑制发生例数明显多于A、B两组（P〈0.05）。结论50≤BIS〈55时，七氟醚吸入麻醉用于老年关节脱位手法复位麻醉效果满意，安全性较高。

Objective To compare different BIS values of sevoflurane inhalation anesthesia anesthetic effect and the safety of the elderly with manipulative reduction for joint dislocation, explore the best BIS on old dislocation reduction value of sevoflurane inhalation anesthesia. Methods Forty eight elderly patients were randomized into three groups with 16 cases each group： groupA, 55≤BIS 〈60,group B, 50≤BIS〈55, group C, 45≤BIS〈50. Established venous access before sevoflurane inhalation. Anesthesia was started with inhalation of 8% sevoflurane, adjusted the inhaling concentration according to the values of BIS, recorded MAP, HR, BIS, time of awakening, anesthetic effect and adverse events. Results Compared with pre-anesthesia, MAP and HR before reduction in group C were decreased significantly （P〈0.05）. Compared with pre-reduction, HR in group A at the time of reduction were increased （P〈0. 05）. Compared with group C, awakening time in groups A and B were decreased significantly （P〈0. 05）. Excellent rate of the anesthetic effect in group A was lower than those in groups B and C （P〈0.05）. The cases of respiratory inhibition in group C were more than those in groups A and B （P〈0.05）. Conclusion When the optimal BIS window is 50-55, for joint dislocation in the elderly, treatment by manipulative reduction under sevoflurane inhalation anesthesia can obtain satisfactory outcomes and little adverse reaction.