摘要
目的探讨脑电意识指数1(IoC1)联合伤害敏感指数2(IoC2)监测在全麻剖宫产术中的应用效果。方法选择60例行全身麻醉下剖宫产手术的患者,ASA分级Ⅰ~Ⅱ级,年龄18~42岁,用随机数字表法将患者平均分为:对照组(C组)以传统血压、心率等临床指标判断麻醉深度指导用药;IoC1联合IoC2监测组(IoC组)以IoC1指导镇静药物的使用,以IoC2指导镇痛药物的使用。观察并记录两组患者的平均动脉压(MAP)、心率(HR),记录术中出现HR、MAP>基础值±20%发生率;比较两组患者丙泊酚用量、瑞芬太尼用量、新生儿阿普加评分、麻醉时间和苏醒时间;比较患者术后疼痛评分、恶心、呕吐和术中知晓发生情况。结果与麻醉诱导前(T0)时间点相比,两组患者在麻醉诱导后(T1)时间点HR、MAP均明显降低,C组患者在插管即刻、胎儿娩出后(T2、T3)时间点HR、MAP明显升高,在手术结束时(T4)HR、MAP明显降低(P<0.05);IoC组的HR、MAP仅在T2时间点明显增高。与C组相比,IoC组丙泊酚用量、瑞芬太尼用量和苏醒时间明显减少,术中出现HR、MAP>基础值±20%发生率、术后恶心、呕吐发生率明显减少(P<0.05)。结论在剖宫产施行全身麻醉时,IoC1联合IoC2监测能良好地反映患者意识水平和镇痛程度,指导围术期麻醉用药,缩短麻醉恢复时间,使血流动力学更加稳定,术后并发症减少,有利于提高产科麻醉质量。
Objective To investigate the application of the consciousness index 1(IoC1)combined with injury sensitive index 2(IoC2)in cesarean section under general anesthesia.Methods Sixty patients underwent cesarean section under general anesthesia,ASA gradeⅠ-Ⅱ,aged 18-42.They were randomized into control group(C group);in which depth of anesthesia and intensity of analgesia were evaluated by traditional monitoring,and consciousness index IoC1 combined with injury sensitive index IoC2 group(IoC group)in which IoC1 and IoC2 were used to guide by the depth of sedation and the intensity of analgesia.Mean arterial pressure(MAP)and heart rate(HR)were recorded.The incidence of the HR and MAP fluctuations≥±20%of the baseline,the dosage of propofol,the dosage of remifentanyl and neonatal Apgar score,anesthesia time,wake up time of the two groups were compared.Postoperative pain scores,nausea,vomiting,and intraoperative awareness were compared.Results Compared with the T0 time point,HR and MAP were significantly decreased in two groups at time point T1,HR and MAP in the C group were significantly increased at the time points T2 and T3,and significantly decreased at the end of the operation(T4)(P<0.05).HR and MAP in IoC group increased significantly only at the time point T2.Compared with C group,propofol dosage,remifentanil dosage and the recovery time in the IoC group were significantly reduced,and the incidence of HR and MAP fluctuations beyond 20%of the baseline,postoperative nausea and vomiting were significantly reduced(P<0.05).Conclusions During the general anesthesia for cesarean section,the IoC1 and IoC2 can reflect the level of consciousness and degree of analgesia well.It can monitor the depth of anesthesia and guide the perioperative anesthesia better,shorten the recovery time of anesthesia,make hemodynamics more stable,reduce postoperative complications,and improve the quality of obstetric anesthesia.
作者
袁保红
刘小男
YUAN Bao-hong;LIU Xiao-nan(Department of Anesthesiology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)
出处
《基础医学与临床》
2021年第9期1329-1332,共4页
Basic and Clinical Medicine
基金
卫生部国家临床重点专科建设项目[财社(2011)170号]
重庆市医学重点学科建设项目[渝卫科教(2007)2号]。
关键词
意识指数
伤害敏感指数
剖宫产
consciousness index
injury sensitivity index
cesarean section
