BIS监测下两种快通道麻醉方式应用于鼻内镜手术的比较

目的:观察BIS指导两种快通道麻醉在鼻内镜手术中的应用及麻醉效果。方法:选择60例ASAⅠ-Ⅱ级择期行功能性鼻内镜手术(FESS)患者,随机分为七氟醚诱导维持麻醉组(VIMA组)与异丙酚全凭静脉麻醉组(TIVA组)。VIMA组:8%七氟醚,氧流量8L/min,潮气量法吸入诱导,七氟醚维持麻醉;TIVA组:异丙酚2 mg/kg诱导,异丙酚维持麻醉。两组诱导时都静脉注射瑞芬太尼1μg/kg,罗库溴铵0.6 mg/kg,监测TOF值为0、BIS60并维持5 s后行气管插管。术中静脉泵注瑞芬太尼0.2μg·kg~(-1)·min~(-1),分别调整七氟醚和异丙酚维持剂量使BIS值在气管插管后至手术结束前15 min左右保持在40~60之间,手术最后15 min保持于60~70之间。两组术后进行Steward评分,并比较两组各时点SBP、DBP、HR,拔管时间,快通道麻醉成功率和苏醒期不良反应发生率。结果:VIMA组拔管时间(11.60±2.55 min)比TIVA组的(7.13±3.26 min)明显延长(P0.05);TIVA组快通道成功率显著高于VIMA组(P0.05)。两组苏醒期不良反应的发生情况比较差异无统计学意义(P0.05)。结论:异丙酚全凭静脉麻醉用于鼻内镜手术拔管时间比七氟醚诱导维持麻醉短,快通道麻醉效果更好。

Comparison of Two BIS-Assisted Fast-Track Anesthesia Methods forEndoscopic Sinus Surgery

Objective:To observe the application and anesthetic effect of BIS assisted sevoflurane induction and maintenanceanesthesia with propofol total intravenous anesthesia for endoscopic sinus surgery.Methods:60 ASA I-II patients undergoing electiveendoscopic sinus surgery were randomized into sevoflurane induction and maintenance anesthesia group (group VIMA) and propofoltotal intravenous anesthesia group (group TIVA). Group VIMA: 8%sevoflurane, oxygen flow 8 L/min, tidal volume induction, followedby sevoflurane maintenance; Group TIVA: propofol induction (2 mg/kg) and maintenance. Remifentanil 1 ug/kg and rocuronium 0.6mg/kg were intravenous injected in both groups during anesthesia induction. Tracheal intubation was performed when TOF value reached0 and the BIS was less than 60, remifentanil 0.2 ug·kg-1·min-1 were administrated, anesthesia were adjusted to keep BIS at 40 to 60 rangefromtracheal intubation to 15 minutes before the end of surgery and at 60 to 70 during the last 15 minutes of surgery for both groups. Theextubation time, success rate of fast-track anesthesia and incidence of adverse reactions in both groups were compared.Results:Conclusion: