麻醉深度监测在乳腺全麻手术麻醉管理中的应用效果研究
摘要
目的评价麻醉深度监测在乳腺全身麻醉(简称全麻)手术麻醉管理中的应用效果。方法选择择期行乳腺全麻手术女性患者80例,采用随机数字表法将患者分为非麻醉深度监测组(A组,40例)和麻醉深度监测组(B组,40例)。A组凭经验判断麻醉深度;B组监测麻醉深度指数(CSI),并以此判断麻醉深度。两组均采用丙泊酚、舒芬太尼、右美托咪定靶控静脉输注全麻。记录诱导前、插管即刻、拔离组织、拔管4个时间点平均动脉压(MAP)、心率(HR),同时记录丙泊酚、舒芬太尼用量,以及恢复期拔管时间,镇痛泵接续时间,麻醉恢复室(PACU)留观时间,拔管后5、10、20、30min时Ramsay镇静评分和视觉模拟疼痛评分(VAS疼痛评分)。结果 B组麻醉维持期MAP、HR较A组稳定,丙泊酚、舒芬太尼用量少于A组(P<0.05)。B组拔管时间、镇痛泵接续时间、PACU留观时间短于A组(P<0.05)。拔管后各时间点B组Ramsay镇静评分、VAS疼痛评分低于A组(P<0.05)。A组术中体动2例,术后呼吸抑制1例,B组无术中体动和呼吸抑制患者。两组患者均未出现术中知晓、恢复期躁动现象。结论麻醉深度监测应用于乳腺全麻手术,能指导麻醉管理和精确用药,维持循环稳定,缩短麻醉恢复期时间,提升术后镇痛效果,具有较好的应用价值。
引文
[1]邱红雨,李晶莹,张国庆,等.麻醉深度指数用于全麻手术期间麻醉深度监测的临床评价[J].中国医药指南,2014,12(4):32-33.
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[12]李忠兴,陈方基.应用麻醉深度指数复合喉罩技术对老年患者下腹部手术静脉复合全麻监测的可行性研究[J].中国保健营养:中旬刊,2013,5(5):168-169.
[13]简晓敏,刘焕仪,曾彦茹,等.不同麻醉深度下全麻术后拔出气管导管时患者应激反应与舒适度的比较[J].广东医学,2016,37(12):1900-1903.
[14]钱敏,袁蓉,纪金芬.不同麻醉深度对老年全身麻醉患者术后认知功能的影响[J].江苏医药,2016,42(9):1060-1062.
[15]FLOUDA L,PANDAZI A,PAPAGEORGIOU C,et al.Comparative effects of sevoflurane and propofol based general anaesthesia for elective surgery on memory[J].Arch Med Sci,2013,9(1):105-111.
[2]鹿曼曼,杨改生.麻醉深度监测对全身麻醉恢复时间影响的Mata分析[J].中国医药导报,2016,13(1):71-74.
[3]彭会丽.麻醉深度监测及其在腹腔镜手术麻醉中的应用[J].中外医疗,2015,34(21):65-66.
[4]MOWAFI HA.Spectral entropy as an objective measure of sedation state in midazolam-premedicated patients[J].Saudi J Anaesth,2012,6(2):131-135.
[5]KORMAN LD.Effect of propofol anesthesia on force application during colonoscopy[J].Gastro Intest Endose,2014,79(4):657-662.
[6]OTTO KA.Differential effects of propofol and isoflurane on the relationship between EEG Narcotrend index and clinical stages of anaesthetic depth in sheep undergoing experimental cardiac surgery[J].Vet J,2016,208(1):87-89.
[7]刘陆陆,吕黄伟.不同剂量右美托咪定对靶控麻醉丙泊酚Cp50的影响[J].中国医科大学学报,2013,42(4):344-347.
[8]钟宝琳,黄桂明,李以平,等.Narcotrend监测下右美托咪啶在语言功能区手术中唤醒麻醉的临床研究[J].中国临床药理学杂志,2015,31(19):1916-1918.
[9]姜丽华,赵军博,张怡,等.意识指数监测在妇科腹腔镜手术中的应用[J].临床麻醉学杂志,2014,30(4):363-365.
[10]REVUELTA M,PANIAGUA P,CAMPOS JM,et al.Validation of the index of consciousness during sevoflurane and remifentanil anaesthesia:a comparison with the bispectral index and the cerebral state index[J].Br J Anaesth,2008,101(5):653-658.
[11]BARR J,FRASER GL,PUNTILLO K,et al.Clinical practice guidelines for the management of pain,agitation,and delirium in adult patients in the intensive care unit[J].Crit Care Med,2013,41(1):263-306.
[12]李忠兴,陈方基.应用麻醉深度指数复合喉罩技术对老年患者下腹部手术静脉复合全麻监测的可行性研究[J].中国保健营养:中旬刊,2013,5(5):168-169.
[13]简晓敏,刘焕仪,曾彦茹,等.不同麻醉深度下全麻术后拔出气管导管时患者应激反应与舒适度的比较[J].广东医学,2016,37(12):1900-1903.
[14]钱敏,袁蓉,纪金芬.不同麻醉深度对老年全身麻醉患者术后认知功能的影响[J].江苏医药,2016,42(9):1060-1062.
[15]FLOUDA L,PANDAZI A,PAPAGEORGIOU C,et al.Comparative effects of sevoflurane and propofol based general anaesthesia for elective surgery on memory[J].Arch Med Sci,2013,9(1):105-111.