Objective To explore the effect of anesthetic depth regulated by A-line ARX-index (AAI) and BIS on the intraoperative anesthetic dose and postoperative recovery of gerontal patients suffering total knee replacement surgery under general anesthesia.Methods Sixty old patients undergoing total knee replacement surgery,aged 65-75 y,weighing 45-85 kg,ASA physical status Ⅰ or Ⅱ were divided into group AAI,group BIS and group contract (group CON)(n=20) using the random digits table method.At 1 d before and 1,3,5,7 d after operation,cognitive function was assessed by mini-mental state examination (MMSE) and the scores were recorded.The total drug dosage during general anesthesia,the recovery time extubation time,the observer assessment of sedation (OAA/S) scale and VAS were also recorded.Results Compared with group CON [propofol (810±17) mg,remifentanil (1.26±0.07) mg],both the propofol dosage[group AAI(450±19),group BIS(500±18) mg] and the remifentanil dosage[group AAI(0.78±0.07) mg,group BIS (0.80±0.08) mg] were less (P＜0.05),and that of group AAI was more less than that of group BIS (P＜0.05).The patient's awakening time [group AAI (5.4±1.5) min,group BIS(10.2±1.3) min] and the extubation time[group AAI(7.3±1.6),group BIS (14.5±1.5) min] were shorter than that of group CON[awakening time (15.3±1.8) min,extubation time(18.2±l.7) min](P＜0.05),and the alertness sedation score[group AAI(4.45±0.35),group BIS(3.74±0.43)] was higher than that of group CON(2.85±0.24)(P＜0.05).But there was no significant differences among three groups about the VAS[group AAI(2.0±0.6),group BIS(2.1±0.5),group CON(2.3±0.7)](P＞0.05).There was no significant differences among three groups in the MMSE scores at 1 d before and 1,3,5,7 d after operation (P＞0.05).Conclusions Application of anesthetic depth monitoring can reduce the dosage of anesthetic,shorten the awakening time and extubation time,while has no significant effect on the MMSE.%目的 探讨使用听觉诱发电位指数(A-line ARX-index,AAI)、BIS监测麻醉深度对老年患者全身麻醉下行全膝关节置换术术中麻醉药用量及术后恢复的影响. 方法 择期全身麻醉下行全膝关节置换术的老年患者60例,年龄65～75岁,体重45～85 kg,ASA分级Ⅰ、Ⅱ级,采用随机数字表法将患者分为3组(每组20例):使用AAI监测麻醉深度组(AAI组)、使用BIS监测麻醉深度组(BIS组)和5年以上经验麻醉医师调控麻醉深度组(CON组).于术前ld和术后1、3、5、7d行简明精神状态量表(mini-mental state examination,MMSE)评分,以此评估患者认知功能;记录3组患者的全身麻醉药物用量,术毕时患者的苏醒时间、拔管时间、警觉镇静(observer assessment of sedation,OAA/S)评分和VAS评分. 结果 AAI组和BIS组的丙泊酚用量[(450±19)、(500±18) mg]及瑞芬太尼用量[(0.78±0.07)、(0.80±0.08) mg]比CON组[丙泊酚(810±17)mg、瑞芬太尼(1.26±0.07) mg]少(P＜0.05),AAI组的丙泊酚用量比BIS组更少,差异有统计学意义(P＜0.05);术毕AAI组和BIS组的苏醒时间[(5.4±1.5)、(10.2±1.3) min]和拔管时间[(7.3±1.6)、(14.5±1.5)min]比CON组[苏醒时间(15.3±1.8) min、拔管时间(18.2±1.7) min]短(P＜0.05),与CON组相比,AAI组和BIS组OAA/S评分高[AAI组(4.45±0.35)分、BIS组(3.74±0.43)分、CON组(2.85±0.24)分](P＜0.05);3组患者VAS评分[AAI组(2.0±0.6)分、BIS组(2.1±0.5)分、CON组(2.3±0.7)分]差异无统计学意义(P＞ 0.05);3组术前ld,术后1、3、5、7d时MMSE评分比较,差异无统计学意义(P＞0.05). 结论 应用麻醉深度监测可以节俭麻醉药用量,缩短苏醒和拔管时间,但是对MMSE评分没有明显影响.
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