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| 意识指数监测对老年患者腹腔镜胆囊切除术中血流动力学的影响 |
| Effect of index of consciousness monitoring on hemodynamic parameters in elderly patients undergoing laparoscopic cholecystectomy |
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| DOI：10.12089/jca.2025.11.006 |
| 中文关键词: 意识指数 脑电双频指数 血流动力学参数变化率 腹腔镜胆囊切除术 老年 |
| 英文关键词: Index of consciousness Bispectral index Rate of change of the hemodynamic parameters Laparoscopic cholecystectomy Aged |
| 基金项目:科技部国家医学研究中心后补助经费（303-01-001-0272-03） |
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| 中文摘要: |
目的：探讨基于意识指数（IoC）监测指导老年患者腹腔镜胆囊切除术的麻醉管理对术中血流动力学指标的影响。
方法：选择择期行全身麻醉下腹腔镜胆囊切除术的患者60例，男20例，女40例，年龄≥65岁，BMI≥18.5 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：BIS组和IoC组，每组30例。记录麻醉诱导前即刻（T0）、插管5 min（T1）、气腹5 min（T2）、头高右高位即刻（T3）、牵拉胆囊即刻（T4）、停气腹5 min（T5）、恢复床位即刻（T6）、缝皮即刻（T7）、拔管后5 min（T8） 的HR、MAP、心脏指数（CI）及每搏量指数（SVI），计算T1—T8时HR、 MAP、CI、SVI的变化率（ROC）的绝对值|ROC|。记录术后24 h静息和活动时VAS疼痛评分、术后恶心呕吐（PONV）的发生情况、术后首次肛门排气时间、首次进食时间及首次下地活动时间。
结果：与BIS组比较，IoC组T1 时|ROCHR|≤10%比例明显升高，T7时|ROCHR|＞20%比例明显降低（P<0.05）；T5时|ROCMAP|≤10%比例明显升高，T6、T7时|ROCMAP|≤10%比例明显升高，T1、T7时|ROCMAP|＞20%比例明显降低，T5、T6时|ROCMAP|＞20%比例明显降低（P<0.05）；T7时|ROCCI|＞20%比例明显降低（P<0.05）；T7时|ROCSVI|≤10%比例明显升高，T4时|ROCSVI|＞10%～20%比例明显升高，T7时|ROCSVI|＞20%比例明显降低（P<0.05）。与BIS组比较，IoC组术后24 h活动时VAS疼痛评分、PONV发生率均明显降低（P<0.05），术后首次进食时间明显缩短（P<0.05）。
结论：在全身麻醉下腹腔镜胆囊切除术的老年患者中，与常规BIS监测比较，采用基于IoC监测指导麻醉管理的患者血流动力学指标波动幅度更小。 |
| 英文摘要: |
Objective: To explore the effect of anesthesia management based on the monitoring of index of consciousness (IoC) on intraoperative hemodynamic parameters in elderly patients undergoing laparoscopic cholecystectomy.
Methods: Sixty patients scheduled for elective laparoscopic cholecystectomy under general anesthesia were selected, 20 males and 40 females, aged ≥ 65 years, BMI ≥ 18.5 kg/m2, ASA physical status Ⅱ or Ⅲ. The patients were divided into two groups by random number table method: BIS group and IoC group, 30 patients in each group. HR, MAP, cardiac index (CI) and stroke volume index (SVI) were recorded immediately before anesthesia induction (T0), 5 minutes after intubation (T1), 5 minutes after pneumoperitoneum (T2), immediately after head height right high position (T3), immediately after gallbladder traction (T4), 5 minutes after pneumoperitoneum arrest (T5), immediately after returning to bed (T6), immediately after suturing the skin (T7), and 5 minutes after extubation (T8). The absolute value of rate of change |ROC| of HR, MAP, CI, and SVI at T1-T8 were calculated. The VAS pain score at rest and during activity 24 hours after the operation, the occurrence of postoperative nausea and vomiting (PONV), the time of the first anal exhaust after the operation, the time of the first meal after the operation, and the time of the first ambulation after the operation were also recorded.
Results: Compared with BIS group, the proportion of |ROCHR| ≤ 10% at T1 was significantly increased, the proportion of |ROCHR| > 20% at T7 was significantly decreased, the proportion of |ROCMAP| ≤ 10% at T5 was significantly increased, the proportion of |ROCMAP| ≤ 10% was significantly increased at T6 and T7, the proportion of |ROCMAP| > 20% was significantly decreased at T1 and T7, the proportion of |ROCMAP| > 20% was significantly decreased at T5 and T6, the proportion of |ROCCI| > 20% was significantly decreased at T7, the proportion of |ROCSVI| ≤ 10% was significantly increased at T7, the proportion of |ROCSVI| > 10%-20% was significantly increased at T4, and the proportion of |ROCSVI| > 20% was significantly decreased at T7 in IoC group (P < 0.05). Compared with BIS group, the VAS pain score during activity 24 hours after the operation and the incidence of PONV were both significantly decreased, and the time to the first meal after surgery was significantly shortened in IoC group (P < 0.05).
Conclusion: Among elderly patients undergoing laparoscopic cholecystectomy under general anesthesia, compared with conventional BIS monitoring, the fluctuation range of hemodynamic indicators in patients under anesthesia management guided by IoC monitoring is smaller. |
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