丙泊酚闭环靶控输注全凭静脉麻醉在颅脑手术的应用

Total intravenous general anesthesia via close-loop target-controlled infusion of propofol and sufentanil for cerebral surgery

目的以脑电双频指数(BIS)为反馈控制变量,探讨丙泊酚闭环靶控输注复合舒芬太尼全凭静脉麻醉应用于颅脑手术的可行性。方法44例择期行大脑半球肿瘤切除患者,随机分为闭环靶控输注组和靶控输注组,各22例。闭环组设定反馈值为BIS=50,两组丙泊酚血浆靶控浓度设定为2．0μg/mL,舒芬太尼恒速持续静脉输注。记录两组在麻醉前、插管即时、插管后3min、切皮、锯颅骨、切开脑皮质、切肿瘤1h、缝皮等时间点的MAP、CVP、HR、HRV、BIS变化及丙泊酚的用量。结果靶控组在插管后3min、切开脑皮质、切肿瘤1h等时间点MAP下降较闭环组明显(P＜0．05),HRV变化幅度也大于闭环组(P＜0．05)。闭环组丙泊酚用量少于靶控组(P＜0．01)。结论以BIS为反馈值,丙泊酚闭环靶控输注复合舒芬太尼全凭静脉麻醉用于颅脑手术,术中患者麻醉深度易于维持,血流动力学稳定,并明显减少丙泊酚用量。

Objective To investigate the feasibility of total intravenous general anesthesia via close-loop target-controlled infusion （CLTCI） in cerebral surgery. Methods 44 patients receiving cerebral tumor resection were divided into close-loop target-controlled group （group C, n=22） and target-controlled group （group T, n=22） randomly. In group C, Bispectral index（BIS） was set at 50, as the feedback control variable, while the serum target-controlled concentration of propofol was set at 2.0 μg/mL in both groups. Sulfentail was infused at a constant speed. The change in medial arterial pressure （MAP）, central venous pressure（CVP）, heart rate（HR）, heart rate variability（HRV） and BIS were recorded before anesthesia, at tracheal intubation, 3 minutes after intubation, during incision of skin, at cutting of the skull and incision of the cortex, one hour after resection of tumor and at the time of suturing of the skin. The dose of propofol was calculated. Results MAP was decreased significantly 3 minutes after intubation, during incision of cerebral cortex and one hour after resection of tumor in group T compared with group C （P〈0.05）. The change of HRV in group T was larger than in group C （P〈0.05）. The consumed dose ofpropofol was larger in group T （P〈0.01）. Conclusion CLTCI ofpropofol and sulfentanil with a feedback of BIS is safe in cerebral surgery, stable in hemodynamics in patients and of less propofol consumption.