意识指数用于无痛胃镜中麻醉用药的指导意义

摘要

【目的】探讨意识指数（IOC）应用于无痛胃镜检查对麻醉用药的指导意义。【方法】选取本院拟进行无痛胃镜检查的80例患者采用随机数字表法分为IOC组和常规组各40例，两组均给予芬太尼1μg／kg、丙泊酚2 mg／kg后，IOC组根据IOC监测值（45～60）给予丙泊酚维持量调节，常规组术中根据一般监测指标和患者体征进行丙泊酚用量调节，比较两组患者麻醉诱导前（T1）、麻醉诱导后（T2）、胃镜插入即刻（T3）、苏醒时（T4）时间点的心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）的波动及麻醉情况。【结果】IOC组和常规组的丙泊酚诱导用量、手术时间比较差异无显著性（P＞00．5），IOC组患者的追加丙泊酚次数、丙泊酚总用量、苏醒时间均显著的低于常规组（P＜00．5）；T1、T2、T4时刻IOC组和常规组患者的 HR、MAP及SpO2监测值相比较差异均无显著性（P＞00．5）；在T3时刻IOC组患者的HR、MAP值显著高于常规组（P＜00．5）；IOC组患者发生体动反应、恶心呕吐、心动过缓的发生率显著的低于常规组（P＜00．5）；两组呼吸抑制、头晕的发生率相比较差异无显著性（P＞00．5）。【结论】IOC应用于无痛胃镜检查有利于更加准确的对患者应用麻醉药物用量，可以有效的达到麻醉效果并且减少不良反应的发生。%[Objective]To explore the significance of the index of consciousness (IOC) in the application of anesthesia in painless gastroscopy .[Methods]Eighty patients who were proposed painless gastroscopy at our hospital Janurary 2015‐December 2015 were selected and randomly assigned into the IOC group ( n=40) and the conventional group ( n=40) . Patients in both groups were given fentanyl (1 μg/kg )and propofol (2 mg/kg) ,but patients in the IOC group received propofol maintenance dose adjusted according to the IOC monitored values (45 to 60) while patients in the conventional group received intraoperative doses of propofol adjusted according to the general patient monitoring indicators and signs . Fluctuation of HR ,MAP ,and SpO2 at time points T1 (before anesthesia induction) ,T2 ( after anesthesia) ,T3 (gastros‐copy insert) ,and T4 ( awakening)were recorded and compared[.Results]Propofol dosage and operation times were not significantly different between the two groups ( P >0 0.5) .However ,the number of additional propofol in the IOC group of patients ,the total amount of propofol ,and recovery times were significantly lower in the IOC group than in the con‐ventional group ( P <0 0.5) .At T1 ,T2 ,and T4 time points ,HR ,MAP ,and SpO2 values were monitored and were not significantly different between the two groups ( P >0 0.5) .At T3 ,HR and MAP values of patients in the IOC group were significantly higher than those of patients in the conventional group ( P <0 0.5) .Body movement reactions ,nausea and vomiting ,and the incidence of bradycardia were significantly lower in IOC group patients than in conventional group patients ( P <0 0.5) .There were no significant differences between patients of the two groups in terms of respiratory de‐pression or the incidence of dizziness ( P >0 0.5) .[Conclusion]The application of IOC in painless gastroscopy is conducive to a more accurate dosage of anesthetic drug .IOC makes the procedure of gastroscopy effectively achieve the effect of an‐esthesia w hile reducing adverse reactions .