脑电双频指数在心脏手术体外循环麻醉深度监测中的应用效果观察被引量：11

The application of BIS for anesthesia depth monitoring in extracorporeal circulation heart surgery

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摘要目的探讨脑电双频指数(Bispectral index,BIS)在心脏手术体外循环麻醉深度监测中的应用效果观察。方法择期行体外循环下心内直视手术患者38例,包括低温体外循环下室缺修补术27例、二尖瓣置换术11例。麻醉诱导采用静脉注射芬太尼10μg/kg、乙托咪酯0.3 mg/kg及维库溴铵0.1 m/kg。麻醉维持采用微量泵持续泵入异丙酚6~10 mg/(kg·h),切皮前静脉注射芬太尼10μg/kg及维库溴铵0.1 mg/kg。转机后体外循环机内加入芬太尼5μg/kg及维库溴铵0.05μg/kg,异丙酚维持原注射剂量不变,在BIS监测下维持麻醉深度处于D2~E1水平。体外循环采用高流量100 ml/(kg·min)非搏动性血流灌注。持续监测麻醉诱导前(T_1)、气管插管(T_2)、CPB前即刻(T_3)、降温至32.0℃(T_4)、阻断前即刻(T_5)、阻断后2min(T_6)、复温即刻(T_7)、停CPB(T_8)、停CPB15 min(T_9)不同时间段BIS、鼻咽温度、平均动脉压(MAP)与心率(HR)水平的变化。结果与T1比较,麻醉诱导后各时间点(T_2~T_9)患者BIS与MAP明显降低,差异有统计学意义(P<0.05);与心肺转流术(CPB)前比较,体外循环期间各时间点(T_4~T_7)BIS、鼻咽温度、MAP明显降低,差异有统计学意义(P<0.05)。结论BIS可有效用于监测体外循环下心内直视手术的麻醉深度,确保生命体征平稳。 Objective To investigate the application of bispectral index （BIS） for anesthesia depth monitoring in extracorporeal circulation heart surgery. Methods Thirty-eight patients underwent open-heart surgery under extracorporeal circulation,including 27 with ventricular deficiency repair under low temperature extracorporeal circulation, and 11 with mitral valve replacement. Anesthesia was induced by intravenous injection of fentanyl 10μg/kg, etomidate 0. 3 mg/kg and vecuronium bromide O. 1 m/kg. Maintenance of anesthesia was performed with continuous micro pumping of propofol 6 - 10 mg/（ kg·h）, and intravenous injection of fentanyl 10 μg / kg and vecuronium bromide 0. 1 mg/kg before cutting the skin. After extracorporeal circulation, fentanyl 5 μg/kg, vecuronium bromide 0.05 μg/kg and the same dose of propofol as above were added into the machine. The anesthesia depth was maintained at D2 - E1 levels under BIS monitoring. Extracorporeal circulation used high flow 100 ml/kgo rain of the pulsatile blood flow perfusion. The changes of BIS,nasopharyngeal temperature, MAP and HR in different times of pre-anesthesia induction （T1 ）, endotracheal intubation （T2 ）, immediately pre-CPB （T3 ） ,32.0℃ cooled （T4 ）, immediately pre-block （T5 ） and post-blocking for 2 min （T6 ）, thawing （T7 ）, immediately stop CPB （T8） and stop CPB15 min （ T9 ） were continuously monitored. Results Compared to pre-anesthesia induction （ T1 ）, BIS and MAP at each time point （ T2 - T9 ） post-anesthesia induction were significantly lower （ P 〈 0. 05 ）. Compared to pre- CPB, BIS, nasopharyngeal temperature and MAP at each time point during extracorporeal circulation （ T4 - T7 ） were significantly lower （ P 〈 0. 05）. Conclusion BIS can be effectively used in monitoring anesthesia depth during the open-heart surgery under extracorporeal circulation to ensure stable vital signs.