脑电双频谱指数指导下监测麻醉在老年患者ERCP中应用

Bispectral index guidance of monitored anesthesia care in elderly patients undergoing endoscopic retrograde cholangiopancreatography

目的探讨脑电双频谱指数(BIS)指导下的监测麻醉在老年患者内镜下逆行胰胆造影(ERCP)手术中的应用效果。方法选择2015年1月至2016年7月在沈阳军区总医院拟行ERCP患者80例为研究对象。将患者随机分为监测麻醉组(MAC组)和局部麻醉强化组(LA组),每组各40例。观察并记录两组患者的心率(HR)、平均动脉压(MAP)、呼吸频率(RR)、呼气末二氧化碳分压(P_(ET)CO_2)、脉搏氧饱和度(SpO_2),以及术中肢体躁动情况,呕吐呛咳等不良反应,患者、术者舒适满意度。结果 MAC组患者的出室时间明显长于LA组(P<0.05);在T_3、T_4、T_5时点,MAC组的MAP和HR变化幅度明显小于LA组(P<0.05);MAC组的肢体躁动情况和呕吐呛咳反应明显少于LA组(P<0.05);呼吸抑制次数明显多于LA组(P<0.05);呼吸道梗阻次数两组比较,差异无统计学意义(P>0.05)。两组患者均无反流误吸发生。MAC组的医患镇静/镇痛满意度明显高于LA组(P<0.05)。结论 BIS指导下的监测麻醉能更安全、有效、舒适的完成手术,是一种满意度高的麻醉方法,更适合高龄行ERCP术患者。

Objective To investigate the application effect of bispectral（ BIS） index guidance of monitored anesthesia care（ MAC） in elderly patients undergoing endoscopic retrograde cholangiopancreatography（ ERCP）. Methods A retrospective study was performed on 80 elderly patients underwent ERCP in the General Hospital of Shenyang Military Command from January 2015 to July2016. Patients were randomly divided into the monitored anesthesia care group（ MAC group） and local anesthesia group（ LA group）,with 40 cases in each group. The heart rate（ HR）,Mean arterial pressure（ MAP）,respiratory rate（ RR）,partial pressure end-tidal CO2（PETCO2） and pulse oximeter saturation（ SpO2） in the two groups were observed and recorded. The intra-operative body agitation,adverse reactions,such as patients with vomiting,choking and cough,performance and comfortable satisfaction of patients were recorded as well. Results The length of operation in MAC group was significantly longer than that in LA group（ P〈0. 05）. The variations of MAP and HR at T3,T4,T5 in MAC group were significantly lower than those in LA group（ P〈0. 05）. The frequency of movement,vomiting and choking in MAC group were significantly less than those in LA group（ P〈0. 05）. The frequency of respiratory depression in MAC group were significantly more than that in LA group（ P〉0. 05）. There was no significant difference between the two groups on airway obstruction（ P〈0. 05）. There was no countercurrent mistake inhalation in both groups. The satisfaction degree of sedation and analgesia in MAC group were significantly higher than those in LA group（ P〈0. 05）. Conclusion BIS index guidance of monitored anesthesia care can be more safe,effective and comfortable to complete the operation,which is an anesthesia method with a high satisfaction degree of sedation and analgesia and is more proper for elderly patients undergoing ERCP.