意识指数监测在无痛肠镜检查术中的应用效果

Clinical effect of index of consciousness in painless enteroscopy

目的 观察意识指数（index of consciousness,IoC）监测在无痛肠镜检查术中的临床效果。方法 选择自愿行无痛肠镜的男性患者200例,年龄18-65岁,随机均分为观察组（IoC组）和对照组（C组）。两组患者均采用TCI丙泊酚复合瑞芬太尼麻醉,丙泊酚血浆靶浓度从4.0μg/ml起始,瑞芬太尼0.05μg·kg-1·min-1持续泵注。IoC组IoC指数保持在50±3,根据IoC值调整丙泊酚靶浓度;C组术中根据血流动力学及体动反应调整麻醉深度。记录给药前即刻（T1）、睫毛反射消失（T2）、过脾曲（T3）、过肝曲（T4）和苏醒时（T5）的MAP、HR、SpO2及镜检时间、丙泊酚用量、术后苏醒时间、定向力恢复时间及正常行走时间,观察术中不良反应发生情况。结果 与C组比较,IoC组丙泊酚用量明显减少,苏醒时间及定向力恢复时间明显缩短（P〈0.05）,体动发生率明显降低（P〈0.05）。两组镜检时间、正常行走时间和呼吸抑制、头晕、恶心呕吐等不良反应发生率差异无统计学意义。结论 IoC监测用于无痛肠镜检查术可减少麻醉药物用量,缩短恢复时间。

Objective To investigate clinical effect of monitoring index of consciousness（IoC）during painless enteroscopy.Methods A total of 200 male patients,aged 18-65 years,were recruited and randomly allocated into observation group（group IoC）and control group（group C）.Propofol was titrated based on target controlled infusion（initial plasm concentration 4.0μg/ml）combined with continuous remifentanil 0.05μg·kg^-1·min^-1 administration in both groups.Propofol was adjusted to maintain IoC vaule at 50±3in group IoC,while in group C intraoperative hemodynamic and body dynamic response based on the judgement whether to adjust the depth of anesthesia.MAP,HR and SpO2 were observed in the following timepoints：baseline（T1）,loss of eyelash reflex（T2）,passing splenic flexure of colon（T3）,passing hepatic flexure of colon（T4）and recovery（T5）.Enteroscopic examination time,dosage of propofol,postoperative emergence time,recovery time of orientation,time of normally walking and perioperative side effects were recorded.Results Decreased amount of propol dosage,shorter time of recovery and shorter time of orientation were founded and lowered incidence of body motility was observed in group IoC when compared to group C.There were no statistical significance about enteroscopic examination time,time of normally walking,incidence of respiration inhibition,dizziness and postoperative nausea and vomiting between two groups.Conclusion The IoC monitoring can reduce the dosage of anesthetic drugs and shorten the recovery time in painless enteroscopic examination.