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| 脑电双频指数联合肌松监测在机器人辅助腹腔镜前列腺癌根治术老年患者中的应用 |
| Application of BIS and muscle relaxation monitors in robot-assisted laparoscopic radical prostatectomy |
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| DOI： |
| 中文关键词: 机器人 腹腔镜 前列腺癌 Trendelenburg体位 |
| 英文关键词: Robot Laparoscope Prostatic cancer Trendelenburg position |
| 基金项目:安徽省科技攻关计划项目(1301042204) |
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| 中文摘要: |
| 目的 评价脑电双频指数（BIS）联合肌松监测在机器人辅助腹腔镜前列腺癌根治术老年患者的麻醉管理。方法 选择择期行机器人辅助腹腔镜下前列腺癌根治术的患者100例,年龄65～80岁,ASA Ⅰ或Ⅱ级,随机分为两组:BIS联合肌松监测组(AA组)和常规麻醉组(AC组),每组50例。AA组,丙泊酚以BIS值45～55为目标靶控输注,用肌松监测反馈仪闭环输注顺式阿曲库铵;AC组,根据患者的生命体征及麻醉经验进行麻醉深度的维持和管理。气腹建立后,所有患者采用40° Trendelenburg体位。记录麻醉诱导前(T0)、麻醉插管后即刻(T1)、气腹后10 min(T2)、气腹后60 min(T3)、手术结束时(T4)的BP、HR、气道平台压(Pplat)和气道峰压(Ppeak);记录术中丙泊酚、顺式阿曲库铵、舒芬太尼和瑞芬太尼的用量,血管活性药的使用例数,术后拔管时间及PACU停留时间。结果 T1、T2、T4时AC组MAP明显高于、HR明显快于AA组(P<0.05);T3时AC组MAP明显低于AA组(P<0.05);与T0时比较,T1、T2、T4时AC组MAP明显升高、HR明显加快(P<0.05),T3时AC组MAP明显降低(P<0.05);AA组各时点MAP和HR差异无统计学意义;与T1时比较,T2～T4时两组患者Pplat和Ppeak明显升高(P<0.05);T2、T3时AC组Pplat和Ppeak明显高于AA组(P<0.05); AA组术中丙泊酚和顺式阿曲库铵的用量明显少于,拔管时间和PACU停留时间明显短于AC组(P<0.05)。结论 在机器人辅助腹腔镜前列腺癌根治术中,采用BIS联合肌松监测管理,能将术中血流动力学维持在稳定的范围,减小术中气道压波动,减少全麻药物用量,明显缩短拔管时间和PACU停留时间,改善麻醉苏醒质量。 |
| 英文摘要: |
| Objective To evaluate the effect of bispectral index (BIS) and muscle relaxation monitoring on robot-assisted laparoscopic radical prostatectomy in elderly patients. Methods One hundred elderly patients (aged 65-80 years, ASA Ⅰ or Ⅱ) who underwent robot-assisted laparoscopic radical prostatectomy were randomly allocated into BIS and muscle relaxation monitoring group (group AA, n=50) and control group (group AC, n=50). In group AA, propofol was infused to achieve the BIS value of 45-55, and we monitored the muscle relaxation to conduct closed-loop infusion of cisatracurium. In group AC, we regulated the depth of anesthetic with the patients' vital signs according to anesthetists' experience. Mean arterial pressures (MAP), heart rates (HR), airway platform pressure (Pplat), and airway peak pressure (Ppeak) were recorded at following time points: before anesthesia induction (T0), after anesthesia induction (T1), 10 min (T2), 60 min (T3) after artificial pneumoperitoneum, and the end of operation (T4). We recorded dosage of propofol, cisatracurium, sufentanil, remifentanil, vasoactive agent, extubation time and PACU stay time. Results At T1, T2 and T4, the MAP and HR in group AC were significantly higher than those in group AA (P<0.05); at T3, MAP in group AC were apparently lower than those in group AA (P<0.05). Compared with T0, MAP and HR in group AC were significantly increased at T1, T2 and T4(P<0.05), MAP in group AC were obviously reduced at T3 (P<0.05), MAP and HR in group AC were also fluctuated obviously at different time points. MAP and HR in group AA at each point had no statistically significant difference. Compared with T1, Pplat and Ppeak in the two groups were significantly increased at T2-T4 (P<0.05). Pplat and Ppeak in grpup AC were higher than those in group AA at T2, T3 (P<0.05). Compared with group AC, the dosages of propofol and cisatracurium were less in group AA. The postoperative extubation time and PACU stay time were shorter in group AA. Conclusion BIS and muscle relaxation monitoring in robot-assisted laparoscopic radical prostatectomy can effectively stablize hemodynamics, reduce airway pressure fluctuation and the dosage of anesthetics. It also shortens the extubation time and the PACU stay time and improves the anesthesia recovery quality. |
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