BIS指导给药在重型颅脑损伤患者麻醉诱导阶段的应用

doi:10.3969/j.issn.1671-7171.2021.02.005

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摘要 【目的】 探讨在重型颅脑损伤(severe traumatic brain injury,STBI)患者的麻醉诱导阶段,脑电双频谱指数(bispectral index,BIS)指导下给药的应用价值。【方法】 将52例STBI拟行手术治疗的患者随机分为观察组和对照组,每组26例。观察组依据BIS值给药诱导,静脉缓慢推注丙泊酚,当BIS达到预定值(40~60)时,立即推注舒芬太尼0.4 μg/kg、罗库溴铵0.6 mg/kg,肌松满意后行经口明视下气管插管;对照组依据临床经验及患者体重推注丙泊酚,其余给药方式及插管方式与观察组相同。分别在入室麻醉诱导前(T₀)、气管插管前即刻(T₁)、气管插管后1 min(T₂)、气管插管后5 min(T₃)、气管插管后10 min(T₄),记录两组患者的平均动脉压(MAP)、心率(HR)、脑电双频谱指数(BIS)。同时在T₀、T₁、T₃等时间点抽取患者静脉血,测定其体内血浆皮质醇(plasma cortisol,COR)水平。并记录诱导阶段丙泊酚的用量。【结果】 与T₀相比,给药后两组患者MAP、HR、BIS值均下降,气管插管后MAP 、HR、BIS值均升高,且在T₂达高峰(P<0.05);与观察组相比,对照组MAP、BIS值波动幅度更大,两组间比较的差异有统计学意义(P<0.05)。两组患者T₀时间点COR水平均高于正常值水平,气管插管后两组患者COR水平均升高,但两组间比较的差异无统计学意义(P>0.05)。观察组麻醉诱导阶段丙泊酚的用量为(1.1±0.3)mg/kg,明显少于对照组的(1.7±0.2)mg/kg,两组间比较的差异有统计学意义(P<0.05)。【结论】 在重型颅脑损伤患者麻醉诱导阶段,BIS指导下给药在保证了麻醉深度的同时,可减少丙泊酚的用量,避免了低BIS值现象的发生,使血流动力学更加平稳,同时也可抑制气管插管引起的应激反应,明显优于常规经验给药,具有良好的应用价值。

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关键词 ：颅脑损伤, 脑电描记术, 麻醉, 二异丙酚, 应激,生理学

Abstract：【Objective】 To investigate the application value of bispectral index (BIS) in the anesthesia induction stage of patients with severe traumatic brain injury (STBI). 【Methods】 Fifty-two patients with severe traumatic brain injury (STBI) were randomly divided into the observation group (group N,n=26) and the control group (group C,n=26). In group N, propofol was slowly injected according to the BIS value. In brief, when the BIS value reached the predetermined value (40~60), sufentanil 0.4μg/kg and rocuronium 0.6mg/kg were injected immediately. Then tracheal intubation was performed when muscle relaxation was satisfactory. In group C, propofol was slowly injected according to the doctor's clinical experience and patient's weight. The other administrations and intubation methods were the same as those of group N. Mean arterial pressure (MAP), heart rate (HR) and BIS value were recorded before induction (T₀), before tracheal intubation (T₁), and 1 (T₂), 5 (T₃), 10 (T₄) minutes afterwards. Venous blood samples were collected to determine the plasma cortisol (COR) level at T₀, T₁ and T₃. Besides, the dosage of propofol used during induction was recorded. 【Results】 Compared to T₀, the MAP, HR and BIS value in both groups were significantly decreased after induction and increased after tracheal intubation(P<0.05). Compared with Group N, MAP and BIS value had a significantly wider fluctuation range in Group C(P<0.05). At the point of T₀, COR levels in both groups were higher than the normal level. After tracheal intubation, COR levels in both groups were increased, but there was no significant difference between the two groups(P>0.05). The dosage of propofol in group N was (1.1±0.3)mg/kg, which was significantly lower than that in group C (1.7±0.2)mg/kg; the difference was statistically significant (P<0.05). 【Conclusions】 In the anesthesia induction stage of patients with severe traumatic brain injury, administration under the guidance of BIS can not only ensure the depth of anesthesia, but also inhibit the stress reaction caused by endotracheal intubation. It can also reduce the dosage of propofol used, avoid the occurrence of low BIS value, and make the hemodynamics more stable, which is obviously better than the normal administration.

Key words： Craniocerebral Trauma Electroencephalography Anesthesia Propofol Stress, Physiological

收稿日期: 2020-11-27

中图分类号:

R651.15

基金资助:湖北省自然科学基金资助项目(2019CFB411)

通讯作者: **E-mail:luouu543@163.com

引用本文:

杜振杰, 罗辉宇, 徐阳, 徐姝珺, 左琴蓉, 李清. BIS指导给药在重型颅脑损伤患者麻醉诱导阶段的应用[J]. 医学临床研究, 2021, 38(2): 175-178.
DU Zhen-jie, LUO Hui-yu, XU Yang, et al. Application of BIS-guided Administration in Anesthesia Induction Stage of Patients with Severe Traumatic Brain Injury. JOURNAL OF CLINICAL RESEARCH, 2021, 38(2): 175-178.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2021.02.005 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2021/V38/I2/175

[1] Cortegiani A,Pavan A,Azzeri F,et al. Precision and bias of target-controlled prolonged propofol infusion for general anesthesia and sedation in neurosurgical patients[J].J Clin Pharmacol,2018, 58(5):606-612.
[2] 郭莉, 刘翠翠, 张帅, 等. 不同麻醉方式对重型颅脑损伤急诊手术患者血流动力学的影响[J].中国实用神经疾病杂志, 2015, 18(23):53-55.
[3] 岳云. 如何看待麻醉监测的临床与科学研究[J].临床麻醉学杂志, 2007, 23(7):586-587.
[4] Shimada M,Sugawara A,Kunisawa T,et al. Complementary use of effect site-target controlled infusion and smart pilot view for anesthetic management in semi-awake craniotomy near BIS 85[J].J Neurosurg Anesthesiol,2018,30(1):78-79.
[5] Dussaussoy C,Peres M, Jaoul V, et al.Automated titration of propofol and remifentanil decreases the anesthesiologist's workload during vascular or thoracic surgery: a randomized prospective study[J].J Clin Comput,2014, 28(1):35-40.
[6] Sessler DI,Sigl JC,Kelley SD,et al. Hospital stay and mortality are increased in patients having a "triple low" of low blood pressure, low bispectral index, and low minimum alveolar concentration of volatile anesthesia[J].Anesthesiology,2012, 116(6):1195-1203.
[7] Bergese SD,Uribe AA,Puente EG,et al. A prospective, multicenter, single-blind study assessing indices of SNAP II versus BIS VISTA on surgical patients undergoing general anesthesia[J].JMIR Res Protoc,2017, 6(2):e15.
[8] 张建宁, 江荣才, 朱锡德.脑损伤患者糖皮质激素及其相关指标的变化[J].中华创伤杂志, 2008, 24(4):245-248.
[9] Neckebroek M,Ionescu CM,Van Amsterdam K,et al. A comparison of propofol-to-BIS post-operative intensive care sedation by means of target controlled infusion, Bayesian-based and predictive control methods: an observational, open-label pilot study[J].J Clin Monit Comput,2019,33(4):675-686.
[10] Iannuzzi M,Iannuzzi E,Rossi F,et al. Relationship between bispectral index, electroencephalographic state entropy and effect-site EC50 for propofol at different clinical endpoints[J].Br J Anaesth,2005,94(4):492-495.
[11] Paul DB,Rao GSU . Correlation of bispectral index with glasgow coma score in mild and moderate head injuries[J].J Clin Monit Comput,2006, 20(6):399-404.