目的 探讨麻醉深度监测在老年患者胸科手术围术期麻醉管理的应用价值.方法 老年全身麻醉胸科手术患者60例,随机均分为两组:Ⅰ组采用麻醉深度监测,结合患者生命体征变化指导术中麻醉管理;Ⅱ组未行麻醉深度监测,以患者循环指标调节麻醉深度.连续监测MAP和HR,记录拔管后5、10、20和30 min时的躁动评分和Ramsay镇静评分,术后随访术中知晓情况.结果 两组患者插管即刻的MAP和HR均较诱导前降低(P<0.05),但 Ⅱ 组下降较 Ⅰ 组明显(P<0.05).Ⅰ组患者自主呼吸恢复时间、睁眼时间、完成指令时间和拔管时间均较 Ⅱ 组缩短(P<0.05).拔管后各时点Ⅰ组躁动评分较Ⅱ组低,Ram say镇静评分较Ⅱ组高(P<0.05).术后随访两组患者均无术中知晓发生.结论 老年胸科手术全身麻醉下实施麻醉深度监测能实时调控麻醉深度,有助于维持循环稳定,提高围术期的安全性.%Objective To investigate the application value of anesthesia depth monitoring in elderly patients undergoing thoracic surgery .Methods Sixty elderly patients undergoing thoracic surgery under general anesthesia were randomly divided into two groups with 30 cases each .The depth of anesthesia in group A was monitored and anesthesia was managed according to anesthesia depth combined with vital signs .The depth of anesthesia in group B was not monitored and anesthesia depth was regulated according to the changes of circulation .The MAP and HR were recorded continuously and Ramsay sedation score and restlessness score were evaluated at 5 minutes ,10 minutes ,20 minutes and 30 minutes after extubation .The intraoperative awareness was followed up after surgery .Results The MAP and HR in both groups were lower just before intubation than those anesthesia induction (P<0 .05) ,which were lower in group B than those in group A (P<0 .05) .The times of spontaneous breathing recovery ,eye opening ,completing instruction time and extubation were shorter in group A than those in group B(P<0 .05) .The restlessness score was lower and Ramsay sedation score was higher in group A than those in group B at four time points after extubation (P<0 .05) .There was no intraoperative awareness in both groups .Results The depth of anesthesia can be regulated timely according to anesthesia depth monitoring in elderly patients undergoing thoracic surgery ,which benefits to maintain circulatory stable and improve the safety of anesthesia and surgery .
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