脑电双频指数监测对胃肠外科全麻手术患者麻醉恢复时间影响的回顾性队列研究

The efficacy of bispectral index monitoring on anesthesia recovery time after gastrointestinal surgeries under general anesthesia:a retrospective cohort study

目的探讨脑电双频指数(bispectral index,BIS)监测麻醉深度对胃肠外科全麻手术患者麻醉恢复时间的影响。方法选择四川大学华西医院2016年1月至2016年6月在脑电双频指数(BIS)监测下实施胃肠外科择期手术患者404例为BIS监测暴露组(简称BIS组),选择同期未使用BIS监测的胃肠外科择期手术患者404例为BIS监测非暴露组(简称非BIS组)。主要评价指标为麻醉早期恢复时间,包括手术结束至气管导管拔出时间(t_1)和手术结束至出手术室时间(t_2),同时分析其与患者年龄、手术时长(t_0)以及手术类型(开腹或腹腔镜)的关系。结果两组患者的性别、年龄、体重和ASA分级无统计学差异(P>0.05),两组手术时长无统计学差异(P>0.05)。BIS组的气管导管拔出时间(10.1±4.4 vs.16.4±6.8)和出手术室时间(21.7±12.3 vs.27.4±14.6)均短于非BIS组(P<0.05)。BIS组中高龄人群(>60岁)和长时间手术人群(手术时间>5 h)的麻醉恢复时间均明显短于非BIS组。两组患者组内比较显示,采用开腹或腹腔镜手术方式,麻醉恢复时间均无明显统计学差异。结论胃肠外科择期全麻手术使用BIS监测麻醉深度,患者的麻醉恢复时间更短,且在老年患者及长时间手术人群中尤其明显。开腹或腹腔镜手术之间的麻醉恢复时间则无明显差异。

Objectives To investigate the association of anesthesia recovery time and bispectral index （BIS） monitoring after gastrointestinal surgeries under general anesthesia. Methods A total of 404 cases of selective gastrointestinal surgeries under general anesthesia with BIS monitoring in West China Hospital of Sichuan University from January 2016 to June 2016 were retrieved from anesthesia medical record system as BIS monitoring exposure cohort （group BIS）. In addition, 404 cases of selective gastrointestinal surgeries without BIS monitoring were matched as none BIS monitoring exposure cohort （group non-BIS）. The primary outcome was the anesthesia recovery time, including the time from the end of surgery to endotracheal extubation （t1） and exiting the operation room （t2）. A sub-group analysis was conducted based on patients’ age, length of operation time （t0） and type of surgery（open surgeries vs laparoscopic surgeries）. Results The gender, age, body weight and ASA categories between two groups had no significant differences （P〉0.05）. The length of operation time also had no significant differences between two groups （P〉0.05）. The extubation time （10.1±4.4vs. 16.4±6.8） and OR exiting time （21.7±12.3 vs. 27.4±14.6） in group BIS were shorter than those in group non-BIS （P〈0.05）. This difference was markedly significant among elderly patients （age〉60） or patients undergoing long operations （operation time〉5hours）. Among each group, the recovery time had no significant difference between open surgeries and laparoscopic surgeries. Conclusions There is an association between BIS monitoring and shorter anesthesia recovery time in gastrointestinal surgery, including the time of endotracheal extubation and exiting the operation room. BIS monitoring enhances anesthesia recovery among elderly patients and patients undergoing long-lasting operations in particular. There is no significant difference in anesthesia recovery time between open surgeries and laparoscopic surgeries.