Page 20 - 麻醉与监护论坛2015年第10期

缪文丽 张元信 摘要

山东省青岛解放军第401医院ICU 目的：探讨脑状态指数（cerebral stage index, CSI）在右美托咪啶（dexmedetomodine ,DEX）辅助麻
基金项目：军区后勤科研计划（CJN09L068） 醉中的应用价值。方法：急诊手或上肢外伤患者44例，观察组（D组）18例，对照组（C组）26例。C组为仅用
罗哌卡因（浓度0.375%，40m l）予臂丛阻滞麻醉，D组于臂丛麻醉后给予D E X，负荷量0.8u g/k g以微量泵10m i n
静脉泵入，继以0.4-0.7u g/k g/h的速度维持C S I水平在60～80。观察组记录麻醉前（T0），D E X负荷量静注5m i n
后（T1），D E X负荷量静注10m i n后（T2），麻醉后30m i n（T3）及对照组记录麻醉前（T0），麻醉后5m i n（T1），
麻醉后10min（T2），麻醉后30min（T3）各时间点的Ramsay评分，CSI值，肌电指数(electromyographic,EMG)
值。结果：D组T2、T3时点的R a m s a y评分(平均秩次)高于C组，差异显著(分别为16.11比8.31，P=0.003；31.28比
16.42，P=0.000)，两组间T0、T1时点的CSI、EMG比较无明显差异；D组T2、T3时点的CSI值（中位数）低于C组，差
异显著(分别为69（25）比86（22），P=0.025；80（15）比89（7.5），P=0.019)，D组T2、T3时点的EMG值（中位
数）低于C组，差异显著(分别为23（66.5）比93（32），P=0.007；80（45.5）比96（25.5），P=0.036)。通过
Spearman相关性检验，CSI、EMG均与Ramsay评分呈负相关（分别为r=-0.533,P=0.000, r=-0.538，P=0.000）。
结论：CSI、EMG与Ramsay评分有良好的相关性，将CSI控制在60～80用于指导DEX在非全麻患者中的应用，可以使
患者达到理想的镇静状态，机体完全放松。

关键词：脑功能状态指数；右美托咪啶；镇静；辅助麻醉
责任作者与联系方式：张元信，E-mail: zhangyuanxin133@163.com

脑状态指数指导右美托咪啶在辅助麻醉中的
应用观察

The Clinical Observation of Dexmedetomodine in Assisted Anesthesia Guided by

Cerebral Stage Index

Wen-li Miao, Yuan-xin Zhang

The anesthesiology department of military center of hand surgery, NO 401 Hospital of PLA, Qingdao, 266071, China
Fund: Military Logistics Research Plan (CJN09L068)

Abstract

Objectives: To evaluate the value of dexmedetomodine (DEX) in the assisted anesthesia guided by cerebral stage index (CSI).
Methods: 44 patients with acute hand and upper limber trauma were randomly divided into dexmedetomodine group (group D, 18 cases) and
controller group (group C, 26 cases). Only ropivacaine (0.375% concentration, 40ml）was used in group C , 0.8ug/kg of DEX were used in group
D within 10 min as a bolus, and 0.4-0.7ug·kg-1·h-1 of DEX were infused continuously monitored by CSI within 60-80. Ramsay score , CSI value and
electromyographic (EMG) value were recorded on before anesthesia （T0）, 5 minutes after bolous of DEX (T1）, 10 minutes after bolous of DEX (T2）
and 30 minutes after anesthesia （T3） in group D , accordingly before anesthesia （T0）, 5 minutes after anesthesia (T1）, 10 minutes after anesthesia
(T2） and 30 minutes after anesthesia （T3） in group C.
Results: Ramsay score （mean rank）in group D were higher than that of group C with statistical difference in T2 and T3(respectively 16.1vs 8.31，
P=0.003；31.28 vs16.42，P=0.000) ;CSI value (median) in group D were lower than that of group C in T2 and T3 (respectively 69（25）vs 86（22），
P=0.025；80（15）vs 89（7.5），P=0.019) ;EMG value (median) in group D were lower than that of group C in T2 and T3 (respectively 23（66.5）
vs 93（32），P=0.007；80（45.5）vs 96（25.5），P=0.036).By spearman correlation test, there were negative correlation between CSI ,EMG and
Ramsay score(respectively r=-0.533,P=0.000, r=-0.538，P=0.000）.
Conclusion: There were good correlation between Ramsay score and CSI ,EMG .CSI which is under 60～80 can guide DEX in patients except
general anesthesia to reach desired sedation and muscle relaxation.
Key Words: Cerebral stage index; Dexmedetomidine; Sedation; Assisted anesthesia
Corresponding Author: Yuan-xin Zhang, E-mail: zhangyuanxin133@163.com

臂丛阻滞麻醉是手和上肢创伤手术常用的麻醉方法，优点 一、资料与方法
是操作简单快捷，但缺点是患者意识清醒，对手术恐惧、高度 1.一般资料
紧张、对伤情担忧等均会加重应激反应，并抑制免疫功能，增
加术后感染几率，影响肢体功能恢复。因此本研究给予臂丛麻 本研究获得本院伦理委员会同意。选择急诊手或上肢
醉的患者右美托咪啶（dexmedetomodine,DEX）辅助麻醉，并 外伤行臂丛麻醉患者共44例，随机分成2组，其中18例纳
同时行脑状态指数（cerebral stage index,CSI）监测控制镇 入观察组(D组)，男10例，女8例，年龄26～65岁，平均
静深度，探讨CSI指导DEX在非全麻患者的应用价值。 （47.67±11.37）岁，对照组（C组）26例，男15例，女11
例，年龄21～67岁，平均（35.46±15.87）岁。A S A I～I I

Laboratory and Clinical Investigation 59 FAM 2013 Jan/Feb Vol.20 Issue 1
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