现代医院
現代醫院
현대의원
MODERN HOSPITAL
2015年
4期
24-26
,共3页
刘彬%姚爱军%冯祝余%黄健香%张裕丰
劉彬%姚愛軍%馮祝餘%黃健香%張裕豐
류빈%요애군%풍축여%황건향%장유봉
脑电双频指数%静脉全麻%高血压%腹腔镜胆囊切除术%苏醒质量
腦電雙頻指數%靜脈全痳%高血壓%腹腔鏡膽囊切除術%囌醒質量
뇌전쌍빈지수%정맥전마%고혈압%복강경담낭절제술%소성질량
Bispectral index%intravenous anesthesia%hypertension%television laparoscopic cholecystecto -my%analepsia quality
目的：观察脑电双频指数（BIS）指导静脉全麻对高血压腹腔镜胆囊切除术（TVLC）患者苏醒质量的影响。方法80例 ASAⅠ或Ⅱ级拟行 TVLC 的高血压患者，随机分为 BIS 组（B 组）和对照组（C 组），每组40例，B 组根据 BIS 值调整麻醉深度，C 组根据患者的临床体征和麻醉医生经验调整麻醉深度。记录两组患者呼吸恢复时间、拔管时间、定向力恢复时间、麻醉药与血管活性药用量和拔管后不良反应（呛咳、躁动、寒战、恶心呕吐、苏醒延迟、术中知晓）发生率及诱导前（T0）、插管前1 min（T1）、插管后5 min（T2）、气腹后5 min（T3）、手术结束时（T4）、手术后5 min（T5）BP、HR、BIS 值的变化。结果与 C 组比较，B 组的呼吸恢复时间、拔管时间、定向力恢复时间、麻醉药与血管活性药用量以及拔管后不良反应（躁动、呛咳、寒战、恶心呕吐、苏醒延迟）明显减少（p ＜0．05）；与 T0比较，B 组 T1时，C 组 T1、T4、T5时 BP、HR 明显降低，C 组 T2、T3时 BP、HR 明显升高（p ＜0．05），与 C 组比较，B 组术中各时点 BP、HR、BIS 值波动明显减小（p ＜0．05）。结论BIS指导静脉全麻可有效减少高血压 TVLC 患者麻醉药用量和循环波动，改善苏醒质量。
目的：觀察腦電雙頻指數（BIS）指導靜脈全痳對高血壓腹腔鏡膽囊切除術（TVLC）患者囌醒質量的影響。方法80例 ASAⅠ或Ⅱ級擬行 TVLC 的高血壓患者，隨機分為 BIS 組（B 組）和對照組（C 組），每組40例，B 組根據 BIS 值調整痳醉深度，C 組根據患者的臨床體徵和痳醉醫生經驗調整痳醉深度。記錄兩組患者呼吸恢複時間、拔管時間、定嚮力恢複時間、痳醉藥與血管活性藥用量和拔管後不良反應（嗆咳、躁動、寒戰、噁心嘔吐、囌醒延遲、術中知曉）髮生率及誘導前（T0）、插管前1 min（T1）、插管後5 min（T2）、氣腹後5 min（T3）、手術結束時（T4）、手術後5 min（T5）BP、HR、BIS 值的變化。結果與 C 組比較，B 組的呼吸恢複時間、拔管時間、定嚮力恢複時間、痳醉藥與血管活性藥用量以及拔管後不良反應（躁動、嗆咳、寒戰、噁心嘔吐、囌醒延遲）明顯減少（p ＜0．05）；與 T0比較，B 組 T1時，C 組 T1、T4、T5時 BP、HR 明顯降低，C 組 T2、T3時 BP、HR 明顯升高（p ＜0．05），與 C 組比較，B 組術中各時點 BP、HR、BIS 值波動明顯減小（p ＜0．05）。結論BIS指導靜脈全痳可有效減少高血壓 TVLC 患者痳醉藥用量和循環波動，改善囌醒質量。
목적：관찰뇌전쌍빈지수（BIS）지도정맥전마대고혈압복강경담낭절제술（TVLC）환자소성질량적영향。방법80례 ASAⅠ혹Ⅱ급의행 TVLC 적고혈압환자，수궤분위 BIS 조（B 조）화대조조（C 조），매조40례，B 조근거 BIS 치조정마취심도，C 조근거환자적림상체정화마취의생경험조정마취심도。기록량조환자호흡회복시간、발관시간、정향력회복시간、마취약여혈관활성약용량화발관후불량반응（창해、조동、한전、악심구토、소성연지、술중지효）발생솔급유도전（T0）、삽관전1 min（T1）、삽관후5 min（T2）、기복후5 min（T3）、수술결속시（T4）、수술후5 min（T5）BP、HR、BIS 치적변화。결과여 C 조비교，B 조적호흡회복시간、발관시간、정향력회복시간、마취약여혈관활성약용량이급발관후불량반응（조동、창해、한전、악심구토、소성연지）명현감소（p ＜0．05）；여 T0비교，B 조 T1시，C 조 T1、T4、T5시 BP、HR 명현강저，C 조 T2、T3시 BP、HR 명현승고（p ＜0．05），여 C 조비교，B 조술중각시점 BP、HR、BIS 치파동명현감소（p ＜0．05）。결론BIS지도정맥전마가유효감소고혈압 TVLC 환자마취약용량화순배파동，개선소성질량。
Objective To observe the effects of intravenous anesthesia guided by value of BIS on analepsia quality of patients with hypertension in television laparoscopic cholecystectomy (TVLC).Methods 80 hypertensive patients (ASA grade I or II ) sheduled to receive TVLC were randomly divided into BIS groups (Group B) and con-trol groups (Group C), 40 cases in each group, and the depth of anesthesia from patients in Group B were adjusted according to the BIS value, while Group C were adjusted according to the clinical signs of patients and experience from anesthesiologists.The recovery time of autonomous respiration , extubation time, the recovery time of directional ability, dosage of anesthetics and vasoactive drugs , the incidence of adverse reaction after extubation (bucking, rest-lessness, chills, nausea and vomiting, delayed recovery, Intraoperative awareness) and the change of numerical val -ue of BP, HR, BIS from all patients were recorded before induction (T0), 1min before intubation (T1), 5min after intubation(T2), 5min after pneumoperitoneum (T3), the end of operation(T4), and 5min after operation(T5).Re-sults Compared with Group C, the recovery time of autonomous respiration , extubation time, the recovery time of directional ability, dosage of anesthetics and vasoactive drugs , and the incidence of adverse reaction after extubation (bucking, restlessness, chills, nausea and vomiting, delayed recovery) of patients in Group B were decreased signif -icantly (p <0.05); Compared with time of T0, BP and HR of patients in Group B at T1 and Group C at T1, T4, T5 were decreased significantly , and Group C at T2, T3 increased significantly (p <0.05).Compared with Group C, the fluctuations of BP, HR, BIS value of patients in Group B at each time point were significantly reduced (p <0.05).Conclusion Intravenous anesthesia guided by value of BIS can effectively reduce the dosages of anesthetic , narrow hemodynamic fluctuations, and improve analepsia quality of patients with hypertension in TVLC .
