老年患者意识丧失及对伤害性刺激无躯体运动反应时脑电双频指数的变化

Changes in the Bispectral Index in Response to Loss of Consciousness and No Somatic Movement to Nociceptive Stimuli in Elderly Patients.

作者信息

Yang Ning, Yue Yun, Pan Jonathan Z, Zuo Ming-Zhang, Shi Yu, Zhou Shu-Zhen, Peng Wen-Ping, Gao Jian-Dong

机构信息

Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.

出版信息

Chin Med J (Engl). 2016 Feb 20;129(4):410-6. doi: 10.4103/0366-6999.176083.

DOI:10.4103/0366-6999.176083

PMID:26879014

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4800841/

Abstract

BACKGROUND

Bispectral index (BIS) is considered very useful to guide anesthesia care in elderly patients, but its use is controversial for the evaluation of the adequacy of analgesia. This study compared the BIS changes in response to loss of consciousness (LOC) and loss of somatic response (LOS) to nociceptive stimuli between elderly and young patients receiving intravenous target-controlled infusion (TCI) of propofol and remifentanil.

METHODS

This study was performed on 52 elderly patients (aged 65-78 years) and 52 young patients (aged 25-58 years), American Society of Anesthesiologists physical status I or II. Anesthesia was induced with propofol administered by TCI. A standardized noxious electrical stimulus (transcutaneous electrical nerve stimulation, [TENS]) was applied (50 Hz, 80 mA, 0.25 ms pulses for 4 s) to the ulnar nerve at increasing remifentanil predicted effective-site concentration (Ce) until patients lost somatic response to TENS. Changes in awake, prestimulus, poststimulus BIS, heart rate, mean arterial pressure, pulse oxygen saturation, predicted plasma concentration, Ce of propofol, and remifentanil at both LOC and LOS clinical points were investigated.

RESULTS

BISLOCin elderly group was higher than that in young patient group (65.4 ± 9.7 vs. 57.6 ± 12.3) (t = 21.58, P < 0.0001) after TCI propofol, and the propofol Ce at LOC was 1.6 ± 0.3 μg/ml in elderly patients, which was significantly lower than that in young patients (2.3 ± 0.5 μg/ml) (t = 7.474, P < 0.0001). As nociceptive stimulation induced BIS to increase, the mean of BIS maximum values after TENS was significantly higher than that before TENS in both age groups (t = 8.902 and t = 8.019, P < 0.0001). With increasing Ce of remifentanil until patients lost somatic response to TENS, BISLOSwas the same as the BISLOCin elderly patients (65.6 ± 10.7 vs. 65.4 ± 9.7), and there were no marked differences between elderly and young patient groups in BISawake, BISLOS, and Ce of remifentanil required for LOS.

CONCLUSION

In elderly patients, BIS can be used as an indicator for hypnotic-analgesic balance and be helpful to guide the optimal administration of propofol and remifentanil individually.

TRIAL REGISTRATION

CTRI Reg. No: ChiCTR-OOC-14005629; http://www.chictr.org.cn/showproj.aspx?proj=9875.

摘要

背景

脑电双频指数（BIS）被认为对指导老年患者的麻醉护理非常有用，但其在评估镇痛效果方面的应用存在争议。本研究比较了接受丙泊酚和瑞芬太尼静脉靶控输注（TCI）的老年患者和年轻患者在意识消失（LOC）和对伤害性刺激的躯体反应消失（LOS）时BIS的变化。

方法

本研究对52例老年患者（年龄65 - 78岁）和52例年轻患者（年龄25 - 58岁）进行，美国麻醉医师协会身体状况分级为I或II级。采用TCI丙泊酚诱导麻醉。随着瑞芬太尼预测效应室浓度（Ce）增加，对尺神经施加标准化的有害电刺激（经皮电神经刺激，[TENS]）（50 Hz，80 mA，0.25 ms脉冲，持续4 s），直至患者对TENS失去躯体反应。研究了清醒、刺激前、刺激后BIS、心率、平均动脉压、脉搏血氧饱和度、预测血浆浓度、丙泊酚的Ce以及瑞芬太尼在LOC和LOS临床点的变化。

结果

TCI丙泊酚后，老年组的BISLOC高于年轻患者组（65.4 ± 9.7 vs. 57.6 ± 12.3）（t = 21.58，P < 0.0001），老年患者LOC时丙泊酚的Ce为1.6 ± 0.3 μg/ml，显著低于年轻患者（2.3 ± 0.5 μg/ml）（t = 7.474，P < 0.0001）。随着伤害性刺激导致BIS升高，两个年龄组TENS后BIS最大值的平均值均显著高于TENS前（t = 8.902和t = 8.019，P < 0.0001）。随着瑞芬太尼Ce增加直至患者对TENS失去躯体反应，老年患者的BISLOS与BISLOC相同（65.6 ± 10.7 vs. 65.4 ± 9.7），老年和年轻患者组在BISawake、BISLOS以及LOS所需瑞芬太尼的Ce方面无明显差异。