意识指数监测对老年腰椎融合术患者应激性高血糖的影响

Effect of index of consciousness on stress‑induced hyperglycemia in elderly patients undergoing lumbar spinal fusion

目的探讨意识指数(IoC)监测[镇静(IoC1)联合镇痛(IoC2)监测]对老年腰椎融合术患者应激性高血糖的影响。方法选择2020年7月至2020年12月行腰椎融合术的老年患者72例,美国麻醉医师协会(ASA)分级Ⅱ、Ⅲ级,按随机数字表法分为两组(每组36例):对照组(C组)和试验组(E组)。两组均采用气管内插管全身麻醉,麻醉维持采用靶控输注丙泊酚、瑞芬太尼及间断静脉注射罗库溴铵。C组根据患者心率及有创血压等生命体征调整丙泊酚及瑞芬太尼血浆靶浓度,E组根据IoC1值变化调整丙泊酚血浆靶浓度,根据IoC2值变化调整瑞芬太尼血浆靶浓度,维持IoC1在40~60、IoC2在35~45。记录两组患者一般资料及手术情况,术中丙泊酚、瑞芬太尼、舒芬太尼、艾司洛尔、去甲肾上腺素用量,术中高血压、低血压、心动过速、心动过缓发生情况,麻醉诱导前(T_(0))、术毕(T_(1))、术后24 h(T_(2))、术后72 h(T_(3))时的血糖及皮质醇浓度,应激性高血糖发生情况,T_(2)、T_(3)时静息和咳嗽时的视觉模拟评分法(VAS)疼痛评分。结果两组患者一般资料及手术情况差异无统计学意义(均P>0.05)。E组患者术中瑞芬太尼用量高于C组(P<0.05),术中高血压发生率低于C组(P<0.05),应激性高血糖发生率低于C组(P<0.05),T_(1)、T_(2)时血糖及皮质醇浓度低于C组(均P<0.05)。与T_(0)时比较,两组患者T_(1)、T_(2)时血糖及皮质醇浓度均升高(均P<0.05)。两组患者T_(2)、T_(3)时静息和咳嗽时的VAS疼痛评分差异无统计学意义(均P>0.05)。结论IoC1联合IoC2监测用于指导老年患者腰椎融合术中镇静及镇痛管理,有利于抑制应激反应并降低应激性高血糖发生率。

Objective To evaluate the effect of index of consciousness(IoC)monitoring,that is the combination of sedation(IoC1)and anesthesia(IoC2)monitoring on stress‑induced hyperglycemia in elderly patients undergoing lumbar spinal fusion.Methods A total of 72 elderly patients,with American Society of Anesthesiologists(ASA)gradesⅡorⅢ,who underwent lumbar spinal fusion from July 2020 to December 2020 were selected.According to the random number table method,they were divided into two groups(n=36):a control group(group C)and an experimental group(group E).Both groups were subject to endotracheal intubation for general anesthesia.Anesthesia was maintained by target‑controlled infusion of propofol and remifentanil as well as intermittent intravenous injection of rocuronium.For group C,the plasma target concentrations of propofol and remifentanil were adjusted,based on vital signs such as heart rate and invasive arterial pressure.For group E,the plasma target concentrations of propofol and remifentanil were adjusted according to the changes of IoC1 and IoC2 values,respectively.The IoC1 and IoC2 values were maintained at 40−60 and 35−45,respectively.Their general and surgical information were recorded.The intraoperative dosages of propofol,remifentanil,sufentanil,esmolol and norepinephrine,as well as the occurrence of hypertension,hypotension,tachycardia,and bradycardia were recorded.The blood glucose and cortisol concentrations were measured before anesthesia induction(T_(0)),at the end of surgery(T_(1)),and at postoperative 24 h(T_(2))and 72 h(T_(3)).The incidence of stress‑induced hyperglycemia was recorded.The Visual Analog Scales(VAS)score at rest and on coughing were recorded at T_(2)and T_(3).Results There was no statistical difference in general and surgical information between the two groups(all P>0.05).Compared with group C,group E showed increases in the intraoperative dosage of remifentanil(P<0.05),decreases in the incidence of intraoperative hypertension(P<0.05),decreases in the incidence of stress‑induced hyperglycemia(P<0.05),and decreases in glucose and cortisol concentrations at T_(1)and T_(2)(all P<0.05).The glucose and cortisol concentrations in both groups at T_(1)and T_(2)were higher than those at T_(0)(all P<0.05).There was no statistical difference in VAS scores at rest and on coughing between the two groups at T_(2)and T_(3)(all P>0.05).Conclusions IoC1 and IoC2 monitoring is beneficial for suppressing stress response and reducing the incidence of stress‑induced hyperglycemia in elderly patients undergoing lumbar spinal fusion.