丙泊酚闭环靶控输注对增殖性糖尿病视网膜病变合并肾功能衰竭患者眼底术中麻醉深度和血流动力学的影响

The effect of closed-loop target controlled infusion of propofol on anesthesia depth and hemodynamics during fundus surgery in patients with proliferative diabetic retinopathy combined with renal failure

目的探讨丙泊酚闭环靶控输注对增殖性糖尿病视网膜病变(PDR)合并肾功能衰竭患者眼底术中麻醉深度和血流动力学的影响。方法本研究为随机对照试验。前瞻性选择2021年6月至2023年4月于首都医科大学附属北京同仁医院全身麻醉下择期行眼底玻璃体切割术(PPV)的PDR合并肾功能衰竭患者70例,根据丙泊酚不同靶控输注方式,采用随机数字表法分为两组(n=35):闭环靶控输注组和手动靶控输注组。两组患者均行全静脉麻醉及喉罩通气,设定麻醉维持脑电双频指数(BIS)目标值为45~55,术中静脉泵注瑞芬太尼,间断推注顺阿曲库铵。比较两组患者BIS<40、40≤BIS≤60及BIS>60持续时间百分比,以及两组患者不同时间点的平均动脉压(MAP)、心率、BIS值、丙泊酚血浆浓度、血管活性药使用率及术后不良反应发生率的差异。结果闭环靶控输注组40≤BIS≤60持续时间百分比为(84.4±2.7)%,高于手动靶控输注组的(65.7±3.8)%;BIS<40及BIS>60持续时间百分比分别为(11.2±3.2)%及(4.4±1.4)%,均低于手动靶控输注组的(28.7±4.8)%及(5.5±1.8)%(均P<0.05)。喉罩置入时、手术开始时闭环靶控输注组患者MAP分别为(79±7)、(77±7)mmHg(1 mmHg=0.133 kPa),高于手动靶控输注组的(74±8)、(72±8)mmHg;丙泊酚血浆靶浓度为(1.8±0.3)、(1.9±0.5)μg/L,低于手动靶控输注组的(2.5±0.3)、(2.6±0.2)μg/L(均P<0.05)。闭环靶控输注组术中麻黄碱和多巴胺使用率分别为31.4%(11/35)和14.3%(5/35),均低于手动靶控输注组的74.3%(26/35)和37.1%(13/35)(均P<0.05)。两组患者苏醒时丙泊酚血浆浓度、术后疼痛、恶心呕吐及高血压等不良反应发生率差异均无统计学意义(均P>0.05)。结论闭环靶控输注丙泊酚能更精确维持PDR合并肾功能衰竭患者全身麻醉深度以及术中血流动力学平稳。

Objective To explore the effect of closed-loop target-controlled infusion of propofol on anesthesia depth and hemodynamics during fundus surgery in patients with proliferative diabetic retinopathy(PDR)combined with renal failure.Methods This study was a randomized controlled trial.A total of 70 patients with PDR combined with renal failure who underwent pars plana vitrectomy(PPV)under general anesthesia at Beijing Tongren Hospital Affiliated to Capital Medical University from June 2021 to April 2023 were selected.According to different target-controlled infusion methods of propofol,patients were divided into two groups(n=35)using the random number table method:closed-loop target-controlled infusion group and manual target-controlled infusion group.Both groups of patients underwent total intravenous anesthesia and laryngeal mask ventilation.The target value of bispectral index(BIS)for anesthesia maintenance was set at 45-55.Remifentanil was pumped intravenously and cisatracurium was injected intermittently during the operation.The proportions of time of BIS<40,40≤BIS≤60 and BIS>60 between the two groups,as well as the differences in mean arterial pressure(MAP),heart rate(HR),BIS value,plasma concentration of propofol,vasoactive drug dosage and incidence of postoperative adverse reactions between the two groups at different time points were compared.Result s The proportion of time of 40≤BIS≤60 in the closed-loop target-controlled infusion group was(84.4±2.7)%,which was higher than(65.7±3.8)%in the manual target-controlled infusion group,while the proportions of time of BIS<40 and BIS>60 were(11.2±3.2)%and(4.4±1.4)%respectively,both lower than(28.7±4.8)%and(5.5±1.8)%in the manual target-controlled infusion group(all P<0.05).The MAP in the closed-loop target-controlled infusion group were(79±7)and(77±7)mmHg(1 mmHg=0.133 kPa)at the time of laryngeal mask placement and at the beginning of the operation,which were significantly higher than those in the manual target-controlled infusion group of(74±8)and(72±8)mmHg(both P<0.05).The propofol plasma concentration in the closed-loop target-controlled infusion group were(1.8±0.3)and(1.9±0.5)μg/L,which were lower than those in the manual target-controlled infusion group of(2.5±0.3)and(2.6±0.2)μg/L(both P<0.05).The intraoperative utilization rates of ephedrine and dopamine in the closed-loop target-controlled infusion group were 31.4%(11/35)and 14.3%(5/35),which were lower than those in the manual target-controlled infusion group of 74.3%(26/35)and 37.1%(13/35,both P<0.05).There were no statistically significant differences in the propofol plasma concentration,postoperative pain,nausea,vomiting,hypertension and other adverse reactions between the two groups during recovery(all P>0.05).Conclusion Closed-loop target-controlled infusion of propofol can more accurately maintain the depth of general anesthesia and stable hemodynamics during surgery in patients with PDR combined with renal failure.