BIS监测在乳癌根治手术硬膜外复合全身麻醉中的应用及镇静效果评价

目的评价脑电双频指数（BIS）监测在乳癌根治手术硬膜外复合全身麻醉（全麻）中的应用及镇静效应的影响。方法选择择期乳癌根治手术患者60例，采用随机数字表法，将患者随机分为单纯全麻组（GA组）和硬膜外复合全麻组（GEA组）。术中维持BIS值在45～55，观察记录麻醉诱导前（TO）、插管前即刻（T1）、插管后1min（T2）、切皮即刻（T3）、乳癌切除时（T4）、术毕即刻（T5）和拔管即刻（T6）的BIS、平均动脉压（MAP）、心率（HR）及麻醉药用量；并详细记录两组患者术毕自主呼吸恢复时间、指令睁眼时间、拔管时间和定向力恢复时间。结果两组患者在T1时段MAP、HR较T0时段明显降低（P〈O．05）；但GAng患者在T2、T5、T6时段HR和MAP均明显高于T0或GEA组同一时段（P〈0．05），两组患者T3、T4时段血流动力学基本稳定于T0水平。两组患者术中维持相同BIS值的情况下，GEA组全麻用药量较GA组明显减少（P〈0．05或P〈0．01），且术毕至自主呼吸恢复时间、指令睁眼时间、拔管时间和定向力恢复时间均较GA组明显缩短（P〈0．05或P〈0．01）。结论BIS监测能指导乳癌根治手术硬膜外复合全麻的精确用药，减轻手术应激反应程度和提供较为稳定的血流动力学。且可防止术中知晓的发生。

Objectives To evaluate the application and the influence on sedative effect of Bispectral index （ BIS ） during epidural block combined with general anesthesia in radical mastectomy. Methods A total of 60 patients underwent radical mastectomy were enrolled and randomly assigned into Group GEA （ epidural combined with general anesthesia, n=30 ） and Group GA according to the random number table. The value of BIS, Mean arterial pressure （ MAP ） ; Heart rate （HR） , and overall consumption of narcotics were recorded on TO （ baseline ） , T1 （ preintubation ） , T2 （ 1 minute post-intubation ） , T3 （ commencement of the operation ） , T4 （ intra-operation ） , T5 （ end of operation ） , T6 （ extubation ） , while the intra-operative BIS value was maintained from 45 to 55, and the recovery of spontaneous respiration, eye opening on indication, time of extubation and the recovery of orientation were also recorded. Results Compared to TO the MAP and HR were significantly lower on T1 in both groups （ P〈0.05 ） . The MAP and HR on T2, T5 and T6 in Group GA were significantly higher than TO and the corresponding time points in Group GA （P〈0.05） . The bemodynamic parameters on T3 and T4 were not significantly different from those ofT0. With identical intraoperative BIS values in both groups, the overall consumption of narcotics and the time needed for the recovery of spontaneous respiration, eye opening on indication, extubation and the recovery of orientation in Group GEA were significantly lower than those of Group GA （ P〈0.05 or P〈0.01 ） .Conclusions BIS monitoring can improve the precision of drug administration, reduce the burden of operative stress, provide stable hemodynamic status and prevent the occurrence of intra-operative awareness during epidural block combined with general anesthesia in radical mastectomy.