丙泊酚靶控输注在老年胃癌根治术麻醉诱导时的应用

Assessment of propofol TCI for anesthesia induction guided by the bispectral index in elderly patients with radical gastrectomy

目的:观察BIS指导丙泊酚靶控输注(TCI)及TCI对老年胃癌根治术患者麻醉诱导气管插管时应激反应的影响。方法:60例70岁以上老年胃癌根治手术患者,随机分为两组,B组和S组,两组病人麻醉诱导均采用分步丙泊酚靶控输注方式进行。B组当BIS达到45-55,进行麻醉插管。S组当OAA/S评分小于3分时,给予肌松药而后插管,记录两组麻醉诱导过程中入室后静卧15min(T0),意识消失(T1),气管插管(T2),气管插管后1min(T3)、3min(T4)、5min(T5)各观察点的心率(HR)、收缩压(SBP)、舒张压(DBP)、BIS值,并记录插管时预测的效应室靶控浓度(Ce)、丙泊酚总量。结果:两组SBP、DBP、HR在T1、T2时降低,T3、T4升高。组内比较:SBP、DBP在T2与T0时比较有显著性差异(P<0.05),T3、T4与T2比较有显著性差异(P<0.05)。HR在B组变化不明显,S组T3、T4与T2比较有显著性差异(P<0.05)。在T3、T4时SBP、DBP、HR组间比较有显著性差异(P<0.05)。结论:以BIS值45-55作为控制变量调控丙泊酚靶控输注在老年胃癌根治手术患者的麻醉诱导,能够降低麻醉诱导时血压下降的幅度及气管插管后的心血管反应,比临床评估的靶控输注更能精确控制麻醉深度,指导麻醉诱导。

Objective：To evaluate the efficacy of propofol TCI guided by the bispectral index on stress responses to tracheal intubation in elderly patients with radical gastrectomy. Methods ： Sixty patients over 70 year - old undergoing radical gastrectomy for stomach cancer were randomized to receive a BIS - guided propofol TCI anesthetic regimen or standard clicical practice. All patients were induced with step - by - step propofol TCI. In group B, tracheal intubation was performed when anesthesia was adjusted to achieve a BIS level 45 -55. In group S, tracheal intubation was performed when standard criteria was achieved. SBP, DBP, HR and BIS were recorded before induction （T0 ） , loss of consciousness （ T1 ）,intubation （ T2 ）, at 1 min （ T3 ）,3 min （ T4 ） and 5 min （ T5 ） after intubation. Effect concentration and dose of propofol were recorded during intubation. Results： Within - group changes, SBP, DBP and HR decreased at T1 ,T2,and increased at T3 ,T4. SBP, DBP were lower at T2 than those at To （P 〈 0.05 ）. SBP, DBP were higher at T3,T4 than those at T2 （ P 〈 0.05 ）. Compared with group S, SBP, DBP, HR were significantly increased at T3,T4 （P 〈 0.05 ）. Condusion： During anesthesia induction propofol TCI guided by the BIS attenuated the increase in both arterial pressure and heart rate after tracheal intubation. Anesthesia induction by TCI of propofol ,the BIS values between 46 to 55 may attenuate the stress responses to tracheal intubation.