脑电双频指数对电针刺激复合硬膜外麻醉用于妇科手术的麻醉效果评价

作者	单位
丰新民	武汉市第一医院麻醉科
李进	武汉市第一医院麻醉科
吴昱	武汉市第一医院麻醉科
毕好生	华中科技学附属同济医院麻醉学教研室

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中文摘要:

目的探讨BIS监测对电针刺激复合硬膜外麻醉用于妇科手术的麻醉效果评价。方法择期妇科手术患者60例,ASAⅠ～Ⅱ级,年龄20～60岁,行硬膜外麻醉,随机分为3组:咪达唑仑组,给予咪达唑仑0.04mg/kg;针麻组,足三里、三阴交穴位予以针刺连续刺激,频率30～100Hz;咪达唑仑加针麻组,给予咪达唑仑0.04mg/kg和足三里、三阴交穴位连续针刺刺激。监测3组患者围手术期脑电双频指数(BIS)值、血压(BP)、心率(HR)、血氧饱和度(SPO2)和术后视觉模拟评分(VAS)。结果3组患者的BIS值与麻醉前比较均有下降(P<0.05),但在切皮时针麻组BIS值最高(P<0.05),咪达唑仑加针麻组BIS值最低(P<0.05),填塞纱布时,针麻组BIS值高于其他两组(P<0.05)。咪达唑仑组患者VAS评分在术后8h、24h高于其他两组(P<0.05)。结论BIS值可以作为针刺复合硬膜外麻醉效果评价的客观指标。针麻具有一定的镇静、镇痛作用,能有效的缓解术后疼痛。

英文摘要:

Objective To evaluate the effect of combined electroacupuncture (EA) and epidural anesthesia in gynecological operation by bispectral index (BIS). Methods Sixty patients of ASA grade Ⅰ-Ⅱ, 20-60 years old, being scheduled to receive gynecological operation with epidural anesthesia were randomly assigned to 3 groups equally. Group A was anesthetized with epidural infusion of midazolam in dosage of 0.04 mg/kg, Group B with continuous EA in 30-100 Hz on Zusanli (ST36) and Sanyinjiao (SP6) acupoints, and Group C with both epidural infusion and EA same as those applied in Groups A and B. BIS, blood pressure (BP), heart rate (HR), and blood oxygen saturation (SPO2) were monitored during peri-operative stage, and the post-operation visual analogue scores (VAS) was measured as well. Results BIS decreased after operation in all groups (P<0.05), the highest value was shown in Group B (P<0.05) and the lowest was seen in group C at time of skin incising; while at time of gauze plugging, it was higher in Group B than in other two groups (P<0.05). Besides, VAS in Group A at 8 h and 24 h after operation was higher than that in the other two groups respectively (P<0.05). Conclusion BIS can be taken as an index for objectively evaluating the effect of combined EA and epidural anesthesia in gynecological operation. EA anesthesia has certain analgesic and sedative effects, could effectively release postoperative pain.

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