颈内动脉内膜剥脱术中脑功能状态指数分布特点及对瑞芬太尼用量的指导价值

Distribution characteristics of cerebral state index during internal carotid endarterectomy and its guiding value for the dosage of remifentanil

目的 探究颈内动脉内膜剥脱术(Carotid endarterectomy,CEA)中脑功能状态指数(Cerebral state index,CSI)分布特点以及对瑞芬太尼用量的指导价值。方法 选择2018年6月-2020年6月邢台市第三医院收治的126例行CEA治疗的颈动脉狭窄患者作为研究对象,采用随机数字表法将患者分为对照组和观察组,每组63例,对照组术中进行常规生命体征监测,观察组在对照组的基础上采用CSI进行监测。比较两组患者的术中CSI分布、血流动力学指标、睫毛反射消失时的瑞芬太尼用量及其血浆浓度、丙泊酚用量、术后麻醉恢复情况、简易精神状态检查量表(Mini-mental state examination,MMSE)评分、视觉模拟评分法(Visual analogue scale,VAS)评分及麻醉前(T0)、临时阻断颈动脉前(T1)、临时阻断颈动脉后(T2)、显露颈动脉即刻(T3)、拔管前(T4)的平均动脉压(Mean arterial pressure,MAP)、心率(Heart rate,HR);采用Pearson分析方法分析瑞芬太尼用量与CSI各指标之间的相关性。结果 两组患者T0时的MAP和HR、丙泊酚用量、术后48 h的MMSE评分、术后6~48 h的VAS评分差异无统计学意义(P>0.05);观察组患者脑惰性、脑耗能、脑排空、脑稳定、脑抑制、内专注、睫毛反射消失时瑞芬太尼用量及其血浆浓度、苏醒时间、拔管时间、定向力恢复时间、麻醉后监测治疗室(Postanesthesia care unit,PACU)停留时间明显低于对照组,记忆加工、困倦、脑内敛、术后24 h内MMSE评分明显高于对照组(P<0.05);对照组患者T2、T3、T4时的MAP、HR明显低于T0时(P<0.05),观察组患者T1、T2、T3、T4时的MAP、HR与T0时比较差异均无统计学意义(P>0.05);瑞芬太尼用量分别与记忆加工、困倦、脑内敛指数呈明显正相关,与脑惰性、脑耗能、脑排空、脑稳定、脑抑制、内专注呈明显负相关(P<0.05)。结论 CSI监测指导CEA能够明显减少瑞芬太尼的用量,维持患者术中血流动力学稳定状态及CSI的正常范围,有利于患者术后的恢复。

Objective To explore the distribution characteristics of cerebral state index(CSI) in internal carotid endarterectomy(CEA) and the guiding value for remifentanil dosage.Methods Totally 126 patients with carotid artery stenosis treated with CEA in Xingtai Third Hospital from June 2018 to June 2020 were selected as the research subjects.The patients were divided into a control group and an observation group by a random number table method,with 63 cases in each group.The control group underwent routine vital signs monitoring during surgery,and the observation group was monitored with CSI on the basis of routine monitoring.The intraoperative CSI distribution,hemodynamic indexes,remifentanil dosage and plasma concentration when eyelash reflex disappeared,propofol dosage,postoperative anesthesia recovery,mini-mental state examination(MMSE) score,visual analogue scale(VAS) score,mean arterial pressure(MAP) and heart rate(HR) before anesthesia(T0),before carotid artery occlusion(T1),after carotid artery occlusion(T2),immediately after carotid artery exposure(T3) and before extubation(T4) were compared between the two groups.The Pearson analysis method was used to analyze the correlation between the amount of remifentanil and CSI indicators.Results There was no significant difference in the MAP and HR at T0,the amount of propofol,the MMSE score at 48 hours after operation,or VAS score at 6~48 hours after surgery between the two groups(P>0.05).Brain inertia,brain energy consumption,brain emptying,brain stability,brain suppression,internal focus,remifentanil dosage and its plasma concentration when eyelash reflex disappeared,awaking time,extubation time,orientation force recovery time and postanesthesia care unit(PACU) stay time were significantly lower in observation group than in control group,while memory processing,drowsiness,brain introversion,and MMSE score within 24 hours after operation were significantly higher(P0.05).The dosage of remifentanil was significantly positively correlated with memory processing,drowsiness,and brain introversion index,and was significantly negatively correlated with brain inertia,brain energy consumption,brain emptying,brain stability,brain depression,and internal focus(P<0.05).Conclusion CSI monitoring and guidance in CEA can significantly reduce the dosage of remifentanil,maintain the patient′s intraoperative hemodynamic stability and the normal range of CSI,which is beneficial to the patient′s postoperative recovery.