镇静指数与镇痛指数联动实施精确麻醉临床应用.docVIP

镇静指数与镇痛指数联动实施精确麻醉临床应用 　　[ 摘要] 目的 探?IoC1与IoC2联动反馈指导麻醉用药在实施精确麻醉中的应用效果。 方法 选取气管插管全身麻醉下行择期手术患者400例，根据随机数字表法将其分为监测组（J组）和常规对照组（C组）各200例。J组患者粘贴Narcotrend和Angel-6000电极片，C组患者仅粘贴Narcotrend电极片。J组患者先以舒芬太尼诱导，剂量为常规的80%，起效后给予丙泊酚静注，逐渐加量，当IoC2出现拐点时记录IoC1值为患者失去知觉值；术中以瑞芬太尼、丙泊酚维持麻醉，根据IoC1与IoC2联动监测值进行调整，并参考Narcotrfed数值对照监测IoC1。C组患者按常规给药方法以舒芬太尼、丙泊酚诱导，以瑞芬太尼、丙泊酚维持麻醉，根据血压、心率等生命体征及Narcotrfed数值进行调整。记录两组患者不同时间点的生命体征、联动指数和Narcotrfed数值，记录两组患者的麻醉时间、手术时间、苏醒时间和拔管时间以及瑞芬太尼和丙泊酚的使用剂量，观察两组患者围手术期并发症的发生情况。 结果 J组患者的平均动脉压、心率和血糖值较C组患者的更加平稳，差异均有统计学意义（P0.05）；J组患者苏醒时间和拔管时间分别为（3.06±1.38）min和（5.12±1.39）min，均明显低于C组患者的（5.68±2.56）min和（7.69±4.43）min，两组差异有统计学意义（P0.05）；J组患者并发症发生率为4.00%，明显低于C组患者的17.50%，差异有统计学意义（P0.05）。 结论 麻醉深度IoC1与IoC2联动指数因其兼顾镇静和镇痛双重监测的特点更接近或符合指导精确麻醉，可在临床推广应用。 　　[关键词] 镇静指数；镇痛指数；全身麻醉；应用效果 　　[中图分类号] R614.24；R737.9 [文献标识码] A [文章编号] 2095-0616（2017）13-113-05 　　[Abstract] Objective To explore application effect of sedation index combined with analgesia index in guiding anesthesia medication in implementing accurate anesthesia. Methods 400 patients undergoing selective surgery under general anesthesia of tracheal intubation were selected.According to random number table，they were divided into the monitoring group （J group） and the routine group （C group） with 200 in each.Patients in J group were pasted Narcotrend and Angel-6000 electrode slices while patients in C group were pasted Narcotrend electrode slices.Patients in J group were induced by sufentanil and the dosage was 80% of the conventional dosage.After taking effect，they were given propofol by intravenous injection and dosage was gradually added.When there was an inflection point in IoC2，IoC1 value was recorded as the unconscious value of for patients.During surgery，remifentanil and propofol were used to maintain anesthesia and they were adjusted according to monitoring values of IoC1 and IoC2.IoC1 was monitored referring to Narcotrend values.Patients in C group were induced by sufentanil and propofol by routine administration method.Remifentanil