慢诱导联合BIS用于超高龄患者全身麻醉的临床观察

Clinical observation of the joint BIS for ultra slow induction of general anesthesia in elderly patients

目的观察健忘镇痛慢诱导联合脑电双频指数(BIS)监测及依托咪酯、瑞芬太尼、顺阿曲库铵全凭静脉麻醉对超高龄患者全身麻醉的临床效果。方法选择30例择期需行全身麻醉的超高龄危重患者,采用随机数字表法随机将其分为A组和B组,每组15例。A组采用健忘镇痛慢诱导气管插管,B组采用快诱导气管插管。分别记录麻醉诱导前(T_0)、诱导后(T_1)、插管即刻(T_2)、插管后3 min(T_3)、手术结束时(T_4)2组患者的有创平均动脉压、心率、脉搏血氧饱和度和呼气末二氧化碳分压、BIS值;记录2组患者拔管后躁动评分、不良反应以及全麻药的用量。结果与诱导前MAP、HR比较,B组在T_1时降低,在T_2、T_3时升高,差异有统计学意义(P<0.05);与A组MAP、HR比较,B组在T_1时降低,在T_2、T_3时升高,差异有统计学意义(P<0.05)。术毕拔管后躁动评分、不良反应例数A组明显低于B组,差异有统计学意义(P<0.05);A组依托咪酯、顺阿曲库铵的用量与B组比较明显减少,差异有统计学意义(P<0.05)。术中各时SpO_2、PETCO_2差异无统计学意义(P>0.05)。结论健忘镇痛慢诱导联合BIS以及依托咪酯、瑞芬太尼、顺阿曲库铵全凭静脉麻醉能安全、有效地用于超高龄患者。

Objective To observe the clinical effects of the joint BIS monitoring and etomidate , remifentanil , cis-atracuri- um total intravenous anesthesia on general anesthesia in elderly patients. Methods Thirty cases required general anes- thesia for elective ultra elderly critically ill patients were randomly divided into group A and group B by using a random number table, 15 cases in each group. Group A were induced analgesia slow endotracheal intubation with amnesia, group B with quick tracheal intubation. Record respectively before anesthesia induction（ TO ） , after induction（ T1 ）, intubation im- mediate （ T2 ） , after intubation 3 min （ T3 ）, surgery （ T4 ） at the end of the two groups of patients with MAP, HR, SpO2 and PETCO2. Record two groups of patients ＇after extubation agitation score, adverse reactions and dosage of anesthetics. Results Compare with before induction MAP, HR ison, group B at T1 decreases in T2 , T3 point increased, the difference was statistically significant （P 〈 0.05 ） ;Compare with group A MAP, HR group B at T1 decrease in T2 , T3 point increased, the difference was statistically significant（ P 〈 0.05 ）. After surgery extubation restlessness score, the number of cases of adverse reactions in group A was significantly lower than group B ,the difference was statistically significant（ P 〈 0.05 ） ; The dosage of etomidate and cis atracurium was reduced in group A than group B. The difference was statistically signifi- eant（P 〈 0.05 ）. Intraoperative each time SpO2 and PETCO2 difference has no statistically significant （P 〉 0.05 ）. Conclusion Joint BIS-induced amnesia and analgesia slow etomidate, remifentanil, cis atracurium total intravenous anes- thesia can be safely and effectively used in very elderly patients.