【摘要】 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。更多还原

【Abstract】 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.更多还原