BIS监测对非体外循环冠状动脉旁路移植术患者应激反应的影响

The effect of BIS monitoring precise anesthesia on stress response in patients undergoing off-pump coronary artery bypass grafting

目的探讨BIS监测下麻醉管理对非体外循环冠状动脉旁路移植术患者术中应激反应的影响。方法河北中石油中心医院2018年1月-2020年12月救治的非体外循环下冠状动脉旁路移植术患者60例,随机分为对照组(A组,常规检测)和脑电双频指数(BIS)监测组(B组,加用BIS监测),每组30例。观察记录入室时(t0)、气管插管时(t1)、切皮时(t2)、开胸时(t3)、离室时(t4)患者的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)、血糖(Glu)及BIS变化,比较麻醉药物用量、不良反应。结果两组患者均顺利完成手术。MAP:与t0比较,两组t1-t4时间点MAP均降低(P<0.05);但与A组比较,B组在t1-t4时间点降低幅度明显减少(P<0.05)。HR:与t0比较,两组患者t1-t4时间点HR均明显降低(P<0.05)。两组SpO2比较,差异无统计学意义(P>0.05)。Glu:与A组比较,B组在t2-t4时间点Glu升高幅度明显较小(P<0.05)。与A组比较,B组的舒芬太尼、丙泊酚用量明显降低(P<0.05)。两组患者均无严重不良反应发生。结论在非体外循环冠状动脉旁路移植术麻醉管理中应用BIS监测,有助于减轻患者的应激反应,减少应激性高血糖和麻醉药物用量。

Objective To explore the effect of precise anesthesia management under BIS monitoring on stress response of patients undergoing off-pump coronary artery bypass grafting(OPCABG).Methods 60 patients scheduled for OPCABG in our hospital from January 2018 to December 2020 were randomly divided into control group(group A)and BIS monitoring group(group B).The changes of MAP,HR,SpO2,Glu and BIS were recorded when entering the room(t0),tracheal intubation(t1),skin incision(t2),thoracotomy(t3)and leaving the room(t4).The dosage of anesthetic drugs and adverse reactions were compared.Results Two groups of patients were successfully completed the operation.MAP:compared with t0,MAP at t1-t4 of two groups were decreased(P<0.05);but compared with group A,MAP at t1-t4 of group B was decreased(P<0.05).HR:compared with t0,HR of t1-t4 time points in two groups were significantly lower(P<0.05).There was no significant difference in SpO2 between the two groups(P>0.05).Glu:compared with group A,Glu in group B increased slightly at t2-t4(P<0.05).Compared with group A,the dosage of sufentanil,propofol and dopamine in group B was significantly lower(P<0.05).There were no serious adverse reactions in the two groups.Conclusion BIS monitoring precise anesthesia is helpful to reduce stress response,stress hyperglycemia,anesthetic dosage and medical expenses in off-pump coronary artery bypass grafting.