微创医学

目的观察麻醉深度指数(CSI)调控下妇科腹腔镜手术快通道麻醉的效果,评价CSI在快通道麻醉中应用的可行性。方法对行妇科腹腔镜手术的60例患者,随机分为对照组(C组)和实验组(T组),两组均以异丙酚、瑞芬太尼、阿曲库铵行麻醉诱导和麻醉维持并行CSI监测。C组根据麻醉医生经验用药,未以CSI反馈指导用药;T组则以CSI反馈调整异丙酚的用量,使CSI值维持在55±5之间。两组术后进行Steward评分,以术毕10 min内(≤10 min)Steward评分达4分及以上(≥4分)拔管者为快通道麻醉实施成功。记录麻醉诱导前(T0)、插管后5 min(T1)、手术开始后5 min(T2)、手术结束时(T3)、拔管前1 min(T4)、拔管后5 min(T5)的CSI值;统计麻醉药用量、拔管时间、离室时间、快通道麻醉成功率及术中知晓、术后躁动情况。结果 T组CSI值低于C组(P=0.000),且存在组间与时点的交互作用(P=0.000);两组患者T0和T6时点的CSI值差异无统计学意义(P>0.05),T组T1、T2、T3、T4、T5时点的CSI值均低于C组(P<0.05)。T组的异丙酚用量明显小于C组(P<0.05),而拔管时间和离室时间早于C组(P<0.05)。T组无术中知晓,C组有2例术中知晓,但组间比较差异无统计学意义(P>0.05);两组术后躁动差异无统计学意义(P>0.05);T组快通道麻醉成功率高于C组(P<0.05)。结论 CSI应用于调控快通道麻醉,可以避免麻醉过深或过浅,防止术中知晓;可以减少全麻药用量,加快麻醉恢复,提早拔管时间和离室时间,从而提高快通道麻醉成功率。

Objective To study the effect of fast-tracking anesthesia regulated by cerebral state index ( CSI) in gynecological laparoscopic operations and evaluate the feasibility of application of CSI in fast-tracking anesthesia． Methods 60 patients with ASAⅠ ～ Ⅱ for gynecological laparoscopic operations were randomly divided into group C ( n = 30) and group T ( n = 30) ， all patients were induced and maintained with propofol， remifentanil and atracurium while monitored by CSI． Group T adjusted the dosage of propofol according to the value of CSI which maintained at 55 ± 5 while group C according to the experience of anesthetist． Steward’s score was assessed at 10 minutes of postoperative to test for success of fast-track anesthesia ( Steward’s score 4 points or more within 10 minutes) ． The value of CSI were recorded at time points: before induction ( T0 ) ， 5 minutes after intubation ( T1 ) ，5 minutes after the beginning of operations ( T2 ) ， the end of operations ( T3 ) ， 1 minute before extubation ( T4 ) ，5 minutes after extubation ( T5 ) ． Anesthetic dosage，extubation-time， postanesthesia care unit ( PACU) stay-time，intraoperative awareness，postoperative agitation were recorded and the success rate of fast-track anesthesia of each group was calculated． Results CSI of group T was lower than that of group C ( P = 0． 000) and there was interaction between groups and time points ( P = 0． 000) ． CSI of group T was lower than that of group C at time points T1 ，T2 ，T3 ，T4 ，T5 ( P ＜ 0． 05) ，but there was no difference between groups at time points T0 and T6 ( P ＞ 0． 05) ． The amount of propofol，extubation-time and PACU stay-time of group T were significantly less than those of group C ( P ＜ 0． 05) ． There was none of intraoperative awareness in group T while 2 in group C，but with no statistics difference between groups ( P ＞ 0． 05) ． There was no statistical difference in postoperative agitation between the two groups ( P ＞ 0． 05) ． The percentage of successful fast-track anesthesia of group T was higher than that of group C ( P ＜ 0． 05) ． Conclusion The application of CSI in fast-tracking anesthesia may avoid deep or light anesthesia and prevent intraoperative awareness． It can increase the percentage of successful fast-track anesthesia by reducing the anesthetic dosage， speeding up recovery，reducing extubation-time and PACU stay-time．