脑电双频指数指导依托咪酯脂肪乳快通道麻醉的临床研究

目的 通过在依托咪酯脂肪乳全凭静脉麻醉中应用脑电双频指数(BIS)监测反馈调控依托咪酯脂肪乳输注速度,探讨依托咪酯脂肪乳快通道麻醉在临床应用中的可行性及安全性.方法 将ASA Ⅰ～Ⅱ级60例择期行全身麻醉患者以抽签形式随机分为实验组(Ⅰ组)和对照组(Ⅱ组),各30例,两组均采用持续泵注依托咪酯脂肪乳、瑞芬太尼、顺式阿曲库铵诱导和维持麻醉.Ⅰ组根据BIS值反馈调整依托咪酯脂肪乳速度维持麻醉深度,使BIS值维持在40～50；Ⅱ组以0.6～1.2mg· kg-1· h-1持续泵注依托咪酯脂肪乳.记录麻醉诱导前、切皮前、切皮时、术中探查时、缝皮时、拔管时的平均动脉压(MAP)、心率(HR)、BIS值、呼气末二氧化碳分压(PetCO2)；记录麻醉时间(T1)、手术时间(T2)、BIS达90的时间(T3)、苏醒时间(T4)、拔管时间(T5)、PACU停留时间(T6)；统计麻醉药用量；记录并发症.结果 Ⅱ组切皮前、切皮时、术中探查时、缝皮时各时间点的BIS值均明显低于Ⅰ组(P＜0.01),两组麻醉诱导前和拔管时的BIS值差异无统计学意义(P＞0.05)；Ⅰ组T3、T4、T5、T6均明显比Ⅱ组缩短(P＜0.01)；Ⅰ组依托咪酯总用量明显少于Ⅱ组(P＜0.01).结论 BIS监测下,依托咪酯脂肪乳用量少,麻醉过程中血流动力学稳定,苏醒快,PACU停留时间短,能达到快通道麻醉要求.

Clinical research of etomidate intralipid applied to fast-track anesthesia monitored by bispectral index

Objective To investigate the clinical feasibility and security of etomidate intralipid applied to fast-track total intravenous anesthesia when bispectral index(BIS) monitoring on infusion rate of etomidate intralipid.Methods Sixty patients of ASAⅠ～Ⅱ scheduled for general anesthesia were randomly divided into two groups of experimental group(groupⅠ) and control group(group Ⅱ),each one with 30 patients.Continuous infusion of etomidate intralipid,remifentanil and cisatracurium was used to both groups to induce and maintain anesthesia.Group Ⅰ adjusted the infusion speed of etomidate intralipid to maintain the depth of anesthesia according to the BIS values,which keeping 40～50.Group Ⅱ maintained the infusion speed of etomidate intralipid with 0.6～1.2mg·kg-1·h-1.The mean arterial pressure(MAP),heart rate(HR),BIS values and PetCO2 were recorded before anesthesia induction,before skin incision,when skin incision,intraoperative exploration,skin closure and tracheal extubation.The duration of anesthesia(T1),operation time(T2),time of BIS value up to 90(T3),recovery time(T4),tracheal extubation(T5),PACU residence time(T6) and dosages of intraoperative anesthetics,and complications were recorded.Results The BIS values before skin incision,when skin incision,intraoperative exploration and skin closure in groupⅡ were obviously less than those in groupⅠ(P<0.01).The differences of BIS values before anesthesia induction and tracheal extubation were no statistical significance in both groups(P>0.05).T3,T4,T5 and T6 in groupⅠ were all shorter than those in groupⅡ(P<0.01).The etomidate consumption was obviously less in group I than those in groupⅡ(P<0.01).Conclusion Monitored by BIS,the dosage of etomidate intralipid is less,providing steady haemodynamics,speeding up the wake and shorting the PACU residence time,meeting the requirements of fast-track anesthesia.