| Objective To explore the effect of different BIS value on stress response and hemodynamics,during perioperative period in elderly patients with gastrointestinal tumor surgery,to provide theoretical basis for eliminate stress response and choose proper depth of anesthesia.Methods From November 2015 to October 2016,a total of 60 patients(aged 65-85)from North China University of Science and Technology Affiliated hospital,classified as American Society of Anesthesiology(ASA)class ?-?,undergoing gastrointestinal tumor surgery with general anesthesia were randomized into 2 groups,namely group L with a target Bispectral index(BIS)maintained at 50~59,group D with a BIS at 40~49.The anesthetics(profopol and remifentanil)were adjusted according to the monitoring results of BIS to maintain the specified anesthesia depth.Both the groups received volume administration guided by stroke volume variation(SVV).The goal SVV was 10±2.Serum levels of cortisol(Cor),adrenocorticotropic hormone(ACTH)and plasma glucose(Glu)were measured by Chemiluminescence method before anesthesia(T0),120 min after extubation(T4)and 60 min after extubation(T6).Heart rate(HR)and mean artery pressure(MAP)were wrote down before anesthesia(T0),subsequent to intubation(T1),at the beginning of the operation(T2),at 60 min after the operation(T3),120 min(T4),at the end of the operation(T5)and 60 min after extubation(T6).Cardiac output(CO),stroke volume(SV)and SVV were recorded at T1~T5.The dosage of propofol and remifentanil,the volume of fluid input,urine output and blood loss were recorded.The time of recovery and extubation,intraoperative awareness and incidence of hypertension were also recorded.SPSS 17.0 statistical analysis software was used for statistical analysis.Measurement data was used by mean±standard deviation((?)±s).Comparisions between two groups were made by two independent samples t-test.Repeated measures analysis of variance was used to compare the differences between different time points in the group.Comparisions of enumeration data used chi-squared test.Difference was considered statistically significant at P<0.05.Results The general situation of the patients such as age,gender,BMI and ASA had no significant differences(P>0.05).There were no obvious differences in serum levels of cortisol,ACTH or Glu between the groups at T0(P>0.05).ACTH,Glu and Cor in two groups all significantly increased at T4 and T6(P<0.05 or P<0.01).And cortisol in group L was markedly higher at T4 and T6 than that in group D(P<0.05).HR in group L increased significantly at T4~T6 compared to those at T0(P<0.05 or P<0.01).MAP declined at T1 and T2(P<0.05),rose at T4~T6(P<0.05 or P<0.01),while the MAP in group D all decreased at T1~T5 compared to those at T0(P<0.05 or P<0.01).HR in group L were markedly higher than those in group D at T4~T6(P<0.05),and MAP at T3~T6(P<0.05).The incidence of hypertension was conspicuously higher in group L than in group D(p<0.05).There were no significant differences in the dosage of remifentanil,anesthesia duration and operation time(P>0.05).The dosage of propofol and volume of fluid input in group L was significantly lower than that in group D(P<0.05).The time of recovery and extubation in group L were significantly shorter than group D(P<0.05).Postoperative recovery comparison of the two groups,no intraoperative awareness occurred to all patients during operation.Conclusions Maintaining the depth of general anesthesia at a BIS value of 40~49 was more conducive to attenuate the serum levels of cortisol than 50~59,which could beter inhibit the stress response.The BIS value of 40~49 can keep the stability of hemodynamics in elderly patients undergoing gastrointestinal tumor surgery.Both of the groups had no complications of anesthesia and intraoperative awareness occurred.The BIS value of 50~59,however,saved dosage of propofol and liquid,reduced the time of recovery and extubation in elderly patients,and also helped postoperative rehabilitation. |
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