意识指数在老年患者胸腔镜肺叶切除术中的应用

Application of index of consciousness in elderly patients undergoing video-assisted thoracoscopic lobectomy

中文关键词: 意识指数  镇静  镇痛  胸腔镜  肺叶切除术  老年

英文关键词: Index of consciousness  Sedation  Analgesia  Thoracoscope  Radical resection of colorectal cancer  Aged

中文摘要:

      
目的 比较意识指数（IoC）与脑电双频指数（BIS）用于指导老年患者行胸腔镜肺叶切除术中的效果。

方法 选择2020年9月至2021年2月行胸腔镜肺叶切除术的老年患者64例，男38例，女26例，年龄65～79岁，BMI 18～30 kg/m²，ASA Ⅰ—Ⅲ 级。采用随机数字表法分为两组：IoC组和BIS组，每组32例。两组均采用双腔管全身麻醉。IoC组采用IoC监测，分为IoC1和IoC2，IoC1监测镇静程度，IoC2监测镇痛程度，调整丙泊酚和瑞芬太尼血浆靶浓度，维持IoC1值40～60，IoC2值35～45。BIS组采用BIS监测，调整丙泊酚血浆靶浓度维持BIS值40～60，根据HR和有创动脉压调整瑞芬太尼血浆靶浓度。记录术中丙泊酚、瑞芬太尼用量和血管活性药使用情况，苏醒时间和拔管时间。记录术后1、2和4 h静息和活动（咳嗽）时VAS疼痛评分和术中高血压、低血压、心动过速、心动过缓、术中知晓、体动等不良事件发生情况。

结果 与BIS组比较，IoC组术中瑞芬太尼用量明显减少（P<0.05），血管活性药物使用率明显降低（P<0.05）。两组术中丙泊酚用量、苏醒时间和拔管时间，不同时点静息和活动时VAS疼痛评分，高血压、低血压、心动过速、心动过缓、术中知晓、体动等不良事件发生率差异无统计学意义。

结论 意识指数IoC1联合IoC2监测用于老年患者行胸腔镜肺叶切除术，可减少术中瑞芬太尼用量和血管活性药物的使用，但不影响丙泊酚用量。

英文摘要:

      
Objective To compare the effect of index of consciousness (IoC) and bispectral index (BIS) in elderly patients undergoing video-assisted thoracoscopic lobectomy.

Methods From September 2020 to February 2021, Sixty-four elderly patients with elective video-assisted thoracoscopic lobectomy, 38 males and 26 females, aged 65-79 years, BMI 18-30 kg/m², ASA physical status Ⅰ-Ⅲ, were randomly divided into two groups: the IoC group and the BIS group, 32 patients in each group. Both groups were given general anesthesia with double lumen tube. IoC monitoring was adopted in the IoC group, and target concentrations of propofol and remifentanil were adjusted to maintain IoC1 values at 40-60 and IoC2 values at 35-45, IoC1 estimated sedation state and IoC2 reflect analgesic depth. The BIS group was monitored by BIS, and the target concentration of propofol was adjusted to maintain BIS value at 40-60. The target concentration of remifentanil was adjusted according to the invasive arterial pressure and HR. The dosage of propofol and remifentanil used during the operation, administration of vasoactive drugs, patient awakening time and extubating time were recorded. The visual analog scales (VAS) score at rest and on coughing were recorded 1 hour, 2 and 4 hours after surgery. The intraoperative adverse events such as hypertension, hypotension, tachycardia, bradycardia, intraoperative awareness, and body movement were recorded.

Results Compared with the BIS group, the dosage of remifentanil and the frequency of administration of vasoactive drugs in the IoC group during operation was significantly reduced (P < 0.05). There was no significant difference in the dosage of propofol, awakening time and extubating time, the rest VAS scores and VAS scores on movement at different time points, the frequency of intraoperative adverse events such as hypertension, hypotension, tachycardia, bradycardia, intraoperative awareness, and body movement between the two groups.

Conclusion The combined monitoring of index ofconsciousness IoC1 and IoC2 can reduce dosage of remifentanil and administration of vasoactive drugs, but does not affect the dosage of propofol in elderly patients undergoing video-assisted thoracoscopic lobectomy.