脑电双频指数监测下全身麻醉联合胸段硬膜外镇痛在快通道胃部手术中的应用

Impact of bispectral index(BIS)guided general anesthesia in combination with thoracic epidural analgesia in fast-track stomach surgery

目的评价BIS监测下的全身麻醉联合胸段硬膜外镇痛对快通道胃部手术的患者苏醒过程和术后早期活动的影响。方法选取2009年1月-2012年3月行快通道开放性胃部手术的患者48例,按随机数字表法分为BIS监测组(B组,n=24)和临床观测组(C组,n=24),所有患者均采用异丙酚全身静脉麻醉复合术中及术后胸段硬膜外镇痛。记录术中平均动脉压(MAP)、心率(HR)、低血压发生率、麻醉药物用量、补液量及麻黄素用量。记录拔管时间、入麻醉恢复室(PACU)即刻改良Aldrete评分及PACU停留时间。记录术后6 h内可活动下肢的例数、排气时间、疼痛视觉模拟评分(VAS)及麻醉满意度评分。结果与C组比较,B组拔管时间和PACU停留时间明显缩短(P<0.01),入PACU即刻改良Aldrete评分明显升高(P<0.05),术中异丙酚用量减少20%(P<0.01),MAP升高(P<0.05),术中低血压例数及麻黄素用量明显减少(P<0.01和P<0.05)。两组患者术后早期活动、排气时间、VAS评分、麻醉满意度评分比较差异无显著性(P>0.05)。结论 BIS监测下全身麻醉联合胸段硬膜外镇痛可降低术中异丙酚用量,缩短拔管时间和PACU停留时间,且不影响术后早期活动,可在临床推广。

【Objective】To examine the impact of BIS-guided anesthesia in a fast-track setting where the goal is rapid recovery. 【Methods】Forty-eight patients undergoing open stomach resection were randomly assigned to receive either BIS-guided（B group, n =24） or clinically-guided（C group, n =24） total IV anesthesia with Propofol after placing a thoracic epidural catheter. MAP, HR, the incidence of hypotension, Propofol consumption, fluid replacement, norepinephrine consumption, time to tracheal extubation, duration of postanesthesia care unit（PACU）stay, Aldrete score on arrival in PACU, early postoperative ability of ambulation, first bowel movement, VAS, patient satisfaction with anesthetic management were assessed. 【Results】In the B group, tracheal extubation was achieved significantly earlier（10.5 min vs 18.5 min, P〈0.01） and the postanesthesia care unit stay was significantly shorter（50 min vs 83 min, P〈0.01）. Total Propofol consumption was reduced by 20% and the incidence of hypotension requiring treatment was significantly lower in the B group（P〈0.01）. Early ambulation, patient satisfaction and incidence of adverse events were not significantly different between the groups. 【Conclusions】BIS-guided IV anesthesia in combination with thoracic epidural analgesia facilitates rapid recovery and reduces the anesthetic drug consumption in patients undergoing fast-track stomach surgery.