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目的:探讨脑电双频指数用于监测阻塞性睡眠呼吸暂停综合征患者经鼻清醒盲探气管插管时镇静深度的安全性和有效性。方法:40例Malampati试验Ⅲ~Ⅳ级的阻塞性睡眠呼吸暂停综合征患者,行经典悬雍垂腭咽成形术。插管前给予咪唑安定、芬太尼,至警觉镇静评分为3分时,经鼻腔盲探气管插管,观察用药前后及插管前后心率、平均动脉压、血氧饱和度、脑电双频指数和警觉镇静评分的变化。结果:患者脑电双频指数值均随镇静深度加深而下降,且与镇静评分下降一致;随警觉镇静评分降低,脑电双频指数、心率和平均动脉压均逐渐降低,与镇静前比较差异有统计学意义(P<0.05);经鼻腔气管插管后1,3 min脑电双频指数、心率和平均动脉压均上升,与插管前警觉镇静评分3分时比较差异有统计学意义(P<0.05);镇静后患者均能耐受气管插管操作,术后随访患者对气管插管过程均无不良回忆。结论:脑电双频指数能准确反映阻塞性睡眠呼吸暂停综合征患者经鼻腔插管时的镇静深度,与警觉镇静评分呈正相关;脑电双频指数值为71~80,警觉镇静评分3分时的镇静深度最适宜行清醒盲探经鼻气管插管。
Objective: To investigate the safety and efficacy of bispectral index for monitoring the sedation depth of patients with obstructive sleep apnea syndrome during nasal awake blind tracheal intubation. Methods: 40 patients with obstructive sleep apnea syndrome of grade Ⅲ ~ Ⅳ in the Malampati trial underwent classic uvulopalatopharyngoplasty. Midazolam and fentanyl were given before intubation. When the sedation score was 3, the nasal blind tracheal intubation was performed. The heart rate, mean arterial pressure, oxygen saturation, Index and alert sedation score changes. Results: The bispectral index (EEG) of patients with EEG decreased with the deepening of sedation and was consistent with the decrease of sedation scores. With the decrease of sedation scores, the bispectral index, heart rate and mean arterial pressure of EEG decreased gradually, compared with those before sedation (P <0.05). The bispectral index, heart rate and mean arterial pressure increased at 1,3 and 3 h after intubation of the nasal endotracheal intubation, which were significantly different from those of the pre-intubation vigilance and sedation score of 3 (P <0.05). After sedation, all patients were able to tolerate tracheal intubation operation. No postoperative memory tracheal intubation was observed in the patients after follow-up. Conclusion: The bispectral index of EEG can accurately reflect the sedation depth of patients with obstructive sleep apnea syndrome during nasal intubation and is positively correlated with the sedation score. The bispectral index value of EEG is 71-80 and the sedation score is 3 When the most appropriate depth of calm sedation blind nasal tracheal intubation.