右美托咪定靶控输注在腰麻中的应用

BIS application in target-controlled infusion of dexmedetomidine in spinal anesthesia

目的通过观察脑电双频指数（BIS）监测右美托咪啶（DEX）靶控输注麻醉深度的准确性,探讨DEX靶控输注在蛛网膜下腔阻滞麻醉中的应用价值。方法选择蛛网膜下腔阻滞麻醉手术患者30例,蛛网膜下腔阻滞后切皮前5 min开始静脉持续泵入DEX。DEX泵注分为3个阶段,泵注的第1阶段为负荷剂量加维持剂量阶段,负荷剂量为2.0μg·kg-1,10~20 min恒速输注完成,之后给予维持剂量0.5μg·kg-1·h-1;第2、3阶段仍为维持阶段,维持剂量分别为1.0μg·kg-1·h-1与1.5μg·kg-1·h-1,在手术结束前20~30 min停止输注DEX。在DEX靶控输注过程中,监测心率、血压、呼吸、脉搏氧饱和度,每隔5 min记录1次BIS值并即刻评估警觉/镇静评分（OAA/S）。结果右美托咪定靶控输注过程中,患者生命体征平稳,心率、血压、呼吸、脉搏氧饱和度及心电活动无明显变化;当DEX输注剂量加大时,BIS值逐渐下降。当OAA/S评分从5逐渐降低至1时,BIS值也相应下降。不同级别OAA/S评分的BIS值之间均有明显差异（P〈0.05）。BIS值与OAA/S评分呈正相关（r=0.695,P〈0.05）。结论 DEX靶控输注在腰麻的应用中,患者生命体征平稳,麻醉效果满意;BIS值能准确地监测DEX靶控输注麻醉的镇静深度,在DEX靶控输注麻醉中能够指导DEX的用量,在临床麻醉中值得推广。

Objective To observe the accuracy of anesthetic depth monitoring using bispectral index （BIS） monitoring on target -controlled infusion of dexmedetomidine （DEX） ,and to explore the application value of target - controlled infusion of DEX in spinal anesthesia. Methods 30 spinal anesthesia patients received continuous intravenous infusion DEX 5min before skin incision. Drugs in the first stage were pumped at a loading dose of 1.0 μg kg-1 for 10min,and maintained with dose of 0.5 μg kg-1 h-1. The second and third stages of the maintenance dose were 1.0 μg kg - 1 h - l, 1.5 μg kg - 1 . h -1, 20 - 30 min before the end of surgery. The HR,BP,respiration,pulse oxygen saturation were monitored and the BIS values every 5min were recorded, and the Alertness/Sedation （OAA/S） was immediately assessed. Results During the target controlled infusion of DEX, the vital signs, heart rate, blood pressure, respiration, pulse oximetry had no significant fluctuations. With increasing doses of DEX infusion, the patient BIS values gradually de- creased. The OAA/S scores decreased from 5 to 1 ,and the BIS values （median） correspondingly reduced. Different levels of OAA/S scores were significantly different between the BIS values （ P 〈 0.05 ）. BIS values and OAA/S score was positively correlated （ r = 0.695 ,P 〈 0.05 ）. Conclusion Target controlled infusion of DEX in spinal anesthesia, the vital signs of patients are stable. The BIS value can be accurately monitored target controlled infusion of DEX sedation,and TCI infusion of DEX can guide the dosage in clinical anesthesia, which is worth promoting.