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| BIS监测下丙泊酚闭环靶控输注用于胆胰手术麻醉的临床效果 |
| Effect of closed-loop target controlled infusion system for propofol administration guided by the bispectral index during anethesia of the biliary tract and pancreas surgeries |
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| DOI： |
| 中文关键词: 脑电双频指数 闭环 开环 靶控输注 丙泊酚 |
| 英文关键词: Bispectral index Closed-loop Opened-loop Target controlled infusion Propfol |
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| 摘要点击次数: 3759 |
| 全文下载次数: 1913 |
| 中文摘要: |
| 目的 观察和比较脑电双频指数(BIS)监测下丙泊酚闭环靶控输注(TCI)在开腹胆胰手术中与人工开环控制麻醉的临床效果。方法 选择择期在全凭静脉麻醉下行开腹胆总管探查、胰腺占位手术的患者40例，男17例，女23例，年龄18～75岁，ASA Ⅱ或Ⅲ级，随机分为两组，每组20例。M组为人工开环组，采用手动调节丙泊酚TCI的效应室靶控浓度行麻醉诱导和维持。C组为闭环靶控组，麻醉诱导和维持由思路高闭环靶控输注系统计算机自动调节丙泊酚的效应室靶控浓度。两组均设定目标BIS值为47，靶控范围为47～52。系统运行后自动记录每秒钟的BIS值。记录意识消失时间、插管时间、苏醒时间、拔管时间、丙泊酚和瑞芬太尼的总用量。记录躁动、恶心呕吐和术中知晓等不良反应情况。记录血管活性药物使用次数。通过BIS值计算执行误差绝对中位数(MDAPE)、摆动(Wobble)和总体分数(GS)。结果 C组BIS值波动幅度在设定值10%(优)以内的时间比例明显高于M组[(52.1±10.5)% vs (37.6±5.8)%，P<0.05]。两组BIS值波动幅度在设定值10%～20%(良)范围以内的时间比例差异无统计学意义。C组MDAPE明显低于M组[(10.1±2.2)% vs (15.3±6.4)%，P<0.05]， C组GS明显低于M组[(23.1±8.9)% vs (33.5±15.8)%，P<0.05]。C组和M组丙泊酚用量[(0.13±0.04) mg·kg-1·min-1 vs (0.12±0.03)mg·kg-1·min-1]和瑞芬太尼用量[(0.12±0.03)μg·kg-1·min-1 vs (0.15±0.05) μg·kg-1·min-1]差异均无统计学意义。M组有1例苏醒期躁动。两组均无恶心呕吐和术中知晓。结论 BIS监测下的丙泊酚闭环靶控输注系统与人工开环靶控输注比较，麻醉镇静深度更合适、平稳。 |
| 英文摘要: |
| Objective To evaluate the accuracy of bispectral index (BIS)-guided closed-loop target controlled infusion (TCI) system in comparison with opened-loop manual TCI during anesthesia of biliary tract and pancreas surgeries. Methods Forty adult patients undergoing open surgery of biliary tract or pancreas under total intravenous anesthesia, including 17 males and 23 females, aged 18-75 years, falling into ASA physical status Ⅱ or Ⅲ, were randomly allocated into closed-loop group (group C, n=20) and opened-loop manual group (group M, n=20). In group M, the propofol effect site concentration was adapted at the discretion of the anesthesiologist to reach and maintain a BIS as close as possible to 42-52. In the closed-loop TCI group, propofol was administered using the closed-loop anesthesia delivery system to reach and maintain atarget BIS of 42-52. The BIS values would be recorded automatically by the system at each second after it began to run. The anesthesia duration, unconsciousness time, endotracheal intubation time, recovery time and endotracheal extubation time were recorded. The total usage of propfol and remifentanil were calculated. The incidence rates of emergence agitation, postoperative nausea and vomiting and intraoperative awareness were recorded. The frequencies of vasoactive drug were recorded. MDAPE, Wobble, GS through BIS values were calculated. Results BIS was maintained within ±10% of target (excellent) for significantly longer time in group C (52.1±10.5)% than that in group M (37.6±5.8)% (P<0.05). BIS was maintained within ±(10%-20%) of target (good) for the same time in both groups. MDAPE in group C (10.1±2.2)% were significantly lower than those in group M (15.3±6.4)% (P<0.05). GS in group C (23.1±8.9)% was significantly lower than that in group M (33.5±15.8)%. The usages of propofol in group C [(0.13±0.04) mg·kg-1·min-1] were similar to those in group M [(0.12±0.03) mg·kg-1·min-1], and the usages of remifentanil in group C [(0.12±0.03) μg·kg-1·min-1] were similar to those in group M [(0.15±0.05) μg·kg-1·min-1]. The frequencies of vasoactive drug were similar in both groups. There was one incidence of emergence agitation in groups M. Postoperative nausea and vomiting and intraoperative awareness didn't occur in both groups. Conclusion The depth of the anesthesia is maitained more appropriately and stable in the closed-loop group than that in manual administration group. |
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