麻醉深度监测在乳腺癌改良根治术患者全凭静脉麻醉中对丙泊酚和瑞芬太尼用量的影响

Effects of Anesthesia Depth Monitoring on the Dosages of Propofol and Remifentanil in Total Intravenous Anesthesia of Patients Undergoing Modified Radical Mastectomy

目的 分析麻醉深度监测在乳腺癌改良根治术患者全凭静脉麻醉中的应用价值。方法 收集全凭静脉麻醉下行单侧乳腺癌改良根治术的100例患者的病例资料,按是否根据意识指数(IoC)进行麻醉深度监测分为IoC组(n = 59)与对照组(n = 41),IoC组麻醉期间根据IoC的变化调节丙泊酚、瑞芬太尼用量;对照组根据生命体征的变化调节丙泊酚、瑞芬太尼用量,统计2组丙泊酚、瑞芬太尼总用量、输注时间及靶浓度调整次数,记录两组患者自主睁眼时间、定向力恢复时间、拔管时间、出手术室时间,比较2组警觉/镇静评分(OAA/S)结果,统计2组围术期不良事件发生率。结果(1)IoC组丙泊酚用量低于对照组,瑞芬太尼用量高于对照组,瑞芬太尼靶浓度调整次数较对照组高(P < 0.05);(2)IoC组自主睁眼时间、定向力恢复时间皆短于对照组(P < 0.05);(3)两组OAA/S评分分级对比差异无统计学意义(P > 0.05);(4)IoC组血压异常及总围术期不良事件发生率均低于对照组(P < 0.05)。结论 麻醉深度监测可指导乳腺癌根治术全凭静脉麻醉中丙泊酚、瑞芬太尼用量,提高患者苏醒质量,减少丙泊酚用量,降低不良事件发生率。

Objective To analyze the application value of anesthesia depth monitoring in total intravenous anesthesia of patients with modified radical mastectomy. Methods The case data of 100 patients who underwent modified radical mastectomy with unilateral breast cancer under general anesthesia were collected. According to the consciousness index (IoC) for anesthesia depth monitoring, the patients were divided into IoC group (n = 59) and control group (n = 41). In IoC group, the dosages of propofol and remifentanil were adjusted according to the change of IoC during anesthesia. In the control group the dosages of propofol and remifentanil were adjusted according to the changes of vital signs. The total dosages of propofol and remifentanil, infusion time and target concentration adjustment frequency were counted in the two groups. The spontaneous blinking time, orientation recovery time, extubation time and time of exiting operating room were recorded in the two groups. The results of observers assessment of alertness/sedation scale (OAA/S) were compared between the two groups. The incidence rate of perioperative adverse events was counted in the two groups. Results The dosage of propofol in IoC group was lower than that in control group while the dosage of remifentanil was higher than that in control group, and the adjustment frequency of remifentanil target concentration was higher than that in control group (P < 0.05). The pontaneous blinking time and orientation recovery time in IoC group were shorter than those in control group (P < 0.05). There was no significant difference in the grading of OAA/S score between the two groups (P > 0.05). The incidence rates of abnormal blood pressure and total perioperative adverse events in IoC group were lower than those in the control group(P < 0.05). Conclusion Anesthesia depth monitoring can guide the dosages of propofol and remifentanil in total intravenous anesthesia for radical mastectomy, improve the awakening quality, reduce the dosage of propofol, and reduce the incidence rate of adverse events.