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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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

Received: 27 November 2020

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

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