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| 脑电双频指数指导下监测麻醉在老年患者慢性硬膜下血肿手术中的应用 |
| Application of bispectral index-guided monitored anesthesia care in surgical treatment of chronic subdural hematoma in elderly patients |
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| DOI： |
| 中文关键词: 脑电双频指数 监测麻醉 老年 慢性硬膜下血肿 |
| 英文关键词: Bispectral index Monitored anesthesia care Elderly patients Chronic subdural hematoma |
| 基金项目:辽宁省自然科学基金（2013020194） |
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| 中文摘要: |
| 目的 探讨脑电双频指数(bispectral index，BIS)指导下的监测麻醉（monitored anesthesia care，MAC）在老年患者慢性硬膜下血肿钻孔引流手术中的应用。方法 选择2014年3月至2015年5月择期行慢性硬膜下血肿钻孔引流手术患者60例，男33例，女27例，年龄65～85岁，ASA Ⅱ～Ⅳ级，随机分为BIS指导下监测麻醉组(M组)和局部麻醉组(C组)，每组30例。M组静脉应用丙泊酚和瑞芬太尼；C组仅采用局部麻醉，未给予任何静脉麻醉药，始终处于清醒状态。记录患者局麻药和血管活性药追加次数。采用Likert 7点量表法分别由患者和术者评估手术镇静/镇痛满意度。记录患者体动、恶心呕吐、反流误吸、呼吸抑制、呼吸道梗阻等不良反应发生情况。结果 M组局麻药和艾司洛尔追加例数明显少于C组，镇静/镇痛满意度明显高于C组(P<0.05)。M组体动发生率明显低于C组(P<0.05)。两组呼吸抑制和呼吸道梗阻发生率差异无统计学意义，均未发生恶心呕吐和反流误吸。结论 脑电双频指数作为反馈控制变量调控镇静麻醉技术可以达到较精确的控制麻醉深度，可安全用于老年患者慢性硬膜下血肿手术。 |
| 英文摘要: |
| Objective To explore the application of monitored anesthesia care (MAC) under the guidance of bispectral index in surgical treatment of chronic subdural hematoma in elderly patients. Methods Sixty patients (33 males, 27 females, aged 65-85 years, ASA physical status Ⅱ-Ⅳ) undergoing sphenotresia drainage of chronic subdural hematoma from March, 2014 to May, 2015 were randomly divided into BIS guided monitored care anesthesia group (group M) and local anesthesia group (group C). Propofol and remifentanil were intravenously infused into patients from group M to maintain BIS index 65-75, vital signs stability and no movement. Local anesthesia was performed before skin incision for each patient. The frequency of medication, the incidence of adverse events were record. The satisfied degree of sedation and analgesia were also evaluated. Results The frequency of movement, local anesthesia drug and additional use of esmolol, were significantly less in group M than those in group C. The satisfaction degree of sedation and analgesia were significantly higher in group M than those in group C (P<0.05). There was no significant difference of respiratory depression and airway obstruction between the two groups. No nausea vomiting reflex and respiration occurred in all groups. Conclusion Bispectral index guidance can be safely applied in surgical treatment of chronic subdural hematoma in elderly patients, which can supply more sedative and analgesic satisfaction than local anesthesia. |
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