丙泊酚靶控输注复合七氟烷用于腹腔镜手术患者麻醉的最佳浓度配比

The best concentration ratio of propofol controlled-infusion combined with sevoflurane in anesthesia for patients undergoing laparoscopy

目的探讨丙泊酚靶控输注联合七氟烷吸入用于腹腔镜胆囊切除术的最佳配伍浓度。方法100例拟在腹腔镜下行胆囊切除术的患者随机分为5组，每组20例，丙泊酚血浆靶控浓度分别为1（组1）、2（组2）、3（组3）、4（组4）和5μg/ml（组5）。调节七氟烷吸入浓度，使脑双频指数值维持在50±5范围内。记录各组呼气末七氟烷浓度（ETsevo）、收缩压、舒张压、苏醒时间、术中知晓发生率和术后24h内恶心呕吐发生率。丙泊酚联合七氟烷最佳配伍定义为术后恶心呕吐发生率不随丙泊酚浓度增加而降低时的最大七氟烷浓度。结果ETsevo与丙泊酚血浆浓度呈负相关，组间收缩压、舒张压、苏醒时间差异无统计学意义，所有患者均无术中知晓。组1和组2术后恶心呕吐发生率差异无统计学意义；组3、组4和组5之间差异无统计学意义，但均显著低于组1。丙泊酚联合七氟烷最佳配伍为丙泊酚靶控浓度3μg／ml联合ETsevo为肺泡最小有效浓度（MAC）。结论丙泊酚靶控浓度3μg/ml联合ETsevo为MAC为最佳配伍浓度，在此浓度下术后恶心呕吐发生率低且有可能防止术中知晓。

Objective To investigate the best concentration ratio of propofol controlled-infusion combined with sevoflurane in anesthesia for patients undergoing laparoscopy. Methods One hundred patients undergoing cholecystectomy under laparoscopy were randomly divided into 5 equal groups treated with propofol controlled plasma at the concentrations of 1,2 , 3 , 4, and 5 μg/ml respectively （ Group 1 - 5）. Bispectral index （BIS） was maintained at a range of 50± 5 by adjusting sevoflurane inhalation. The end-tidal concentration of sevoflurane （ETsevo）, systolic pressure, diastolic pressure, recovery time, awareness, and post-operative nausea and vomiting （PONV） within 24 h after operation were recorded. The best concentration ratio of propofol controlled-infusion combined with sevoflurane with the definition as the highest ETsevo without PONV decrease along with the increase of propofol concentration. Results ETsevo was negatively correlated with and propofol concentration. There were nit significant differences in the systolic pressure, diastolic pressure, and recovery time among different groups. No incidence of intraoperative awareness was found. The PONV rates of Group 1 and 2 were both 60% , significantly higher than those of the other 3 groups （ all P 〈 0.05 ） without significant differences in PONV rate among Group 3 - 5. The best concentration ratio of propofol controlled-infusion combined with sevofiurane was propofol controlledinfusion at the concentration of 1 μg/ml with ETsevo at the concentration as 1 minimal alveolar concentration （MAC）. Conclusion Propofol controlled-infusion at the concentration of 1 μg/ml with ETsevo at the concentration as 1 MAC is the best concentration ratio with low PONV rate and a possibility to prevent intraoperative awareness.