脑电双频指数用于门诊宫腔镜通液术麻醉监测的价值

摘要

Objective To evaluate the value of bispectral index (BIS) monitoring for outpatients undergoing hysteroscopic hydrotubation under propofol-sufentanil anesthesia. Methods From October 2010 to March 2011, 120 patients who received selective hysteroscopic hydrotubation under propofol-sufentanil anesthesia were enrolled in this study. The patients were randomly divided into BIS monitor ( n = 60) and regular monitor groups ( n = 60). After administering sufentanil 5 μg plus propofol 1. 0 mg/kg, we adjusted the dose of propofol by monitoring BIS (40-55, BIS group) , or clinical symptoms (regular group) . The dose of propofol, patients' response during the operation, operation time, and hospital stay were compared between the two groups. Results The dose of propofol in the BIS group was significantly less than the regular group [ (84. 1 ± 10. 7)mg vs. ( 108. 7 ± 15. 3) mg,t = - 10. 206, P = 0.000]. Limbs movement was observed in 2 cases from the BIS group, and 7 from the regular group (χ2 = 1. 922, P =0. 166). The MAP in the regular group was significantly lower than that in BIS group after anesthesia (t = -4. 379,P =0.000) , at the dialation of the cervical os (t = - 5. 863 , P = 0. 000) and fluid infusion (t = - 3. 073, P = 0. 003 ). Intraoperative awareness occurred none in the BIS group, but 3 in the regular group (Fisher' s test, P = 0. 244). Conclusions BIS monitoring can be used during hysteroscopic hydrotubation in outpatient to prevent overdose or shortage of anaesthetics, improve hemodynamic changes, increases surgical safety and decrease the rate of complications.%目的 观察脑电双频指数( bispectral index,BIS)监测对门诊宫腔镜通液术患者麻醉过程及恢复的意义.方法 2010年10月～2011年3月选择我院门诊择期在丙泊酚-舒芬太尼静脉麻醉下行宫腔镜通液术120例,按随机数字表随机分为BIS监测组(n=60)与常规监测组(n=60).静脉给予舒芬太尼5μg、丙泊酚1.0 mg/kg负荷量后,丙泊酚维持量BIS监测组根据BIS( 40～ 55)调节,常规监测组仅根据患者临床体征调节.比较2组丙泊酚用量、术中反应、手术时间及留院观察时间等. 结果 BIS监测组丙泊酚用量(84.1±10.7)mg,显著少于常规监测组(108.7±15.3)mg(t=-10.206,P=0.000).扩宫口时肢动,BIS监测组2例,常规监测组7例,2组发生率无统计学差异(x2=1.922,P=0.166).常规监测组平均动脉压(MAP)在麻醉诱导入睡后(t=-4.379,P=0.000)、扩张宫颈时(t=-5.863,P=0.000)、通液时(t=-3.073,P=0.003),显著低于BIS监测组.术中知晓BIS监测组无发生,常规监测组3例,2组发生率无统计学差异(Fisher'8检验,P=0.244). 结论 BIS监测用于门诊宫腔镜通液术麻醉,预防麻醉药用量不足或逾量,减轻血流动力学改变,有利于提高麻醉安全,减少并发症的发生.