国际麻醉学与复苏杂志   2017, Issue (10): 0-0
    
脑电双频指数-靶控输注注射泵闭环丙泊酚靶控输注应用于妇科腹腔镜手术的安全效益研究
陈鹤翔, 朱斌1()
1.武汉大学人民医院麻醉科
The study of safety and saving efficacy on bispectral index-based closed-loop target controlled infusion propofol with bispectral index-target controlled infusion pump for gynecological laparoscopic surgery
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摘要:

目的 观察BIS-靶控输注(target controlled infusion, TCI)注射泵闭环丙泊酚TCI对妇科腔镜手术患者丙泊酚的节约效应及血流动力学的影响。 方法 纳入ASA分级Ⅰ、Ⅱ级择期行妇科腔镜手术的患者40例,采用计算机随机数字表分组分为闭环组和开环组,每组20例。闭环组采用BIS监测闭环丙泊酚TCI维持全身麻醉,开环组采用BIS监测下人工调整丙泊酚TCI血浆效应浓度2~5 mg/L维持全身麻醉,BIS目标值50±5;瑞芬太尼血浆效应浓度4 μg/L TCI。记录两组在入室后5 min(T0)、诱导后气管插管前(T1)、插管后1 min(T2)、插管后5 min(T3)、手术切皮时(T4)、切皮后30 min(T5)、缝皮(T6)、手术结束(T7)、意识恢复(T8)、拔管即刻(T9)及拔管后5 min(T10)等时点MAP、HR、BIS值的变化,同时记录两组患者诱导及维持丙泊酚用药量、苏醒时间及进入PACU时的疼痛数字评分(numerical rating scale, NRS)及Ramsay镇静评分。 结果 术中维持丙泊酚剂量闭环组[(6.2±1.4) mg·kg-1·h-1]较开环组[(6.9±1.0) mg·kg-1·h-1]降低了10%,两组各时点MAP、HR、BIS差异无统计学意义(P>0.05),闭环组切皮时MAP、HR、BIS波动明显小于开环组(P<0.05)。两组患者苏醒时间、NRS及Ramsay镇静评分差异无统计学意义(P>0.05)。 结论 BIS-TCI注射泵闭环丙泊酚TCI与常规BIS监测下开环丙泊酚TCI可同样安全地应用于临床,可对患者个体化合理给予全身麻醉药物,并可部分降低术中丙泊酚使用剂量,降低麻醉后手术前的循环波动。同时,避免麻醉医师手动调控TCI靶控血浆浓度,极大地降低了麻醉医师的工作量,并使围麻醉期更加平稳安全。

关键词: 脑电双频指数; 靶控输注; 丙泊酚; 腹腔镜外科手术
Abstract:

Objective To observe hemodynamic change and saving efficacy in patients undergone gynecological laparoscopic surgery under closed-loop control of target controlled infusion(TCI) propofol guided by BIS with BIS-TCI pump. To explore the guiding effect and reference value of BIS-TCI pump on accurate implementation of total intravenous anesthesia. Methods Forty patients who experienced gynecological laparoscopic surgery were enrolled in this study and divided into two groups randomly. The anesthesia was maintained with closed-loop control of propofol TCI guided by BIS with BIS-TCI pump in the closed-loop group. While the anesthesia was maintained with manually regulating plasma concentration 2-5 mg/L of propofol TCI guided by BIS with TCI pump in the opened-loop group. The target BIS value was 50±5. The plasma concentration 4 μg/L of remifentanil TCI was used for analgesia. BIS value, MAP, HR were recorded for each patient at the time point of pre-anesthesia, tracheal intubation, 1 min after tracheal intubation, 5 min after tracheal intubation, skin incision, 30 min after skin incision, skin suture, the end of surgery, consciousness recovery, extubation, 5 min after extubation. The consumption of propofol, the anesthesia recovery time, the score of numerical rating scale(NRS) and Ramsay were also recorded.  Results The dosage of propofol during the anesthesia was decreased by 10% in the closedloop group which compared with opened-loop group[(6.2±1.4) mg·kg-1·h-1 vs (6.9±1.0) mg·kg-1·h-1(P>0.05). BIS value, MAP, HR between the two groups had no significant differences at the each time point (P>0.05), but the hemodynamic change at the time point of skin incision was less in the closed-loop group compared with opened-loop group(P<0.05). No significant differences of awaking time of anesthesia, Ramsay sedation and NRS score in the both groups were found(P>0.05). Conclusions Compared with theopened-loop control of propofol TCI guided by BIS with TCI pump, the closed-loop control of propofol TCI guided by BIS with BIS-TCI pump could be safely applied in clinic, made the infusion of anesthetics more individually, and decreased the consumption of propofol. At the same time, closed-loop controlled infusion with BIS-TCI pump can also decrease the anesthesiologist's workload and make patients pass the peri anesthesia period smoothly and safely.

Key words: Bispectral index; Target controlled infusion; Propofol; Laparoscopic surgerical procedures