脑电双频谱指数监测在喉罩麻醉下腹腔镜胆囊切除术中对血流动力学的影响

Effect of BIS on hemodynamics during laparoscopic cholecystectomy under laryngeal mask airway anesthesia

目的 探讨脑电双频谱指数（BIS）监测在喉罩麻醉下腹腔镜胆囊切除术中对血流动力学的影响.方法 选取行腹腔镜胆囊切除术患者110例,按照随机数字表法将其分为对照组和观察组,每组55例,对照组患者根据麻醉医师经验给药,观察组在BIS监测指导下给药,对比两组患者的心率（HR）、平均动脉压（MAP）、皮质醇（COR）等血流动力学指标及麻醉药物用量、苏醒时间等情况.结果 观察组拔除喉罩后HR、MAP、COR水平[（74.13±6.99）次/min、（78.54±8.01）mmHg、（321.23±15.35）nmol/L]明显优于对照组[（94.21±9.53）次/min、（98.67±10.21）mmHg、（463.24±20.01）nmol/L],差异均有统计学意义（t=12.60、11.50、41.76,均P〈0.05）.观察组丙泊酚诱导用量[（1.65±0.21）mg/kg]、丙泊酚总量[（323.13±15.64）mg]、瑞芬太尼总量[（401.21±20.11）μg]明显少于对照组[（2.39±0.34）mg/kg、（414.32±20.34）mg、（469.54±22.39）μg],且观察组麻醉苏醒时间[（6.89±1.01）min]明显短于对照组[（10.21±1.42）min],差异均有统计学意义（t=13.73、26.36、16.84、14.13,均P〈0.05）.结论 BIS监测在喉罩麻醉下腹腔镜胆囊切除术中效果显著,减少术中麻醉药物使用剂量,促进血流动力学稳定,减轻患者的应激反应,缩短苏醒时间,使麻醉过程更安全、可靠.

Objective To explore the effect of bispectral index （BIS） monitoring on hemodynamics patients undergoing laparoscopic cholecystectomy under laryngeal mask anesthesia.Methods 110 patients with laparoscopic cholecystectomy were randomly divided into the control group and the observation group according to digital table method.The control group was administered according to the experience of anesthesiologists,the observation group was administered according to BIS monitoring.The hemodynamic indexes,the dosage of anesthetic drug and recovery time of two groups were analyzed.Results After pulling out the laryngeal mask,the HR （74.13±6.99）beats/min,MAP （78.54±8.01）mmHg and COR （321.23±15.35）nmol/L of the observation group were significantly higher than HR （94.21±9.53）beats/min,MAP（98.67±10.21）mmHg and COR （463.24±20.01）nmol/L of the control group,the differences were statistically significant （t=12.60,11.50,41.76,all P〈0.05）.The amount of propofol induction （1.65±0.21）mg/kg,dosage of propofol （323.13±15.64）mg and remifentanil （401.21±20.11）μg of the observation group were lower than those of the control group [（2.39±0.34）mg/kg,（414.32±20.34）mg,（469.54±22.39）μg],and the recovery time of the observation group （6.89±1.01）min was significantly better than （10.21±1.42）min of the control group,the differences were statistically significant （t=13.73,26.36,16.84,14.13,all P〈0.05）.Conclusion The effect of BIS monitoring in laryngeal mask anesthesia for laparoscopic cholecystectomy is significant,which can reduce intraoperative anesthetic dosage,promote hemodynamic stability,reduce the stress response of patients,shorten recovery time,the anesthesia is more safe and reliable.