BIS监测下靶控输注瑞芬太尼复合丙泊酚在胃肠镜检查中的应用

Application of target-controlled infusion with remifentanyl combined with propofol to patients with gastrointestinal endoscopy under bispectral index monitoring

目的探讨脑电双频指数(BIS)应用于胃肠镜检查中的优势和重要性,观察比较单纯靶控输注(TCI)丙泊酚和TCI瑞芬太尼复合丙泊酚两种方法在胃肠镜检查中的应用价值及不良反应。方法 132例ASAⅠ～Ⅱ级接受胃肠镜检查的病人(35～68岁),随机分成3组(n=44):单纯TCI丙泊酚组(A组),BIS监测TCI丙泊酚组(B组),BIS监测TCI瑞芬太尼复合丙泊酚组(C组)。A组根据病人意识和血流动力学调整血浆丙泊酚TCI靶浓度,B、C组根据BIS值和血流动力学调整丙泊酚和(或)瑞芬太尼TCI血浆靶浓度,术中维持BIS值在45～60。分别记录手术中丙泊酚总量,术后清醒和出院时间,术中呼吸抑制、心动过缓、不自主体动、呛咳、呃逆、术后恶心、呕吐和躁动等不良反应情况。结果三组患者均顺利完成检查,与A组比较,B、C组的丙泊酚总量减少,苏醒和出院时间均缩短,术中体动减少(P<0.05),与B组比较,C组丙泊酚总量减少,苏醒时间缩短(P<0.05),出院时间和体动反应差异无统计学意义(P>0.05),与A、B组比较,C组术中发生呼吸抑制、心动过缓的概率明显增高(P<0.05),三组术中呛咳、呃逆,术后恶心、呕吐、躁动的发生率差异无统计学意义(P>0.05)。结论 BIS监测下TCI瑞芬太尼复合丙泊酚用于胃肠镜检查的价值在于可以达到更合理的麻醉深度以减少术中不良刺激反应,且能减少丙泊酚用量,保证术后麻醉快速苏醒,缺点是需要特殊设备并需加强术中呼吸循环管理。

Objective To discuss the advantage and importance of bispectral index（BIS）monitoring used in gastrointestinal endoscopy,and to observe and compare values and side-effects of two ways of anesthesia,i.e.target-controlled infusion（TCI）single propofol and remifentanyl combined with propofol.Methods One hundred and thirty two patients aged from 35 to 68 with ASA physical status I-II were randomly divided into three groups,i.e.Group A（TCI propofol）,Group B（TCI propofol with BIS）,and Group C（TCI remifentanyl and propofol with BIS）.Plasma target concentration of propofol was adjusted by consciousness and hemodynamics in Group A,while by both BIS value and hemodynamics in Group B.BIS was controlled at 45-60.The total amount of propofol,the time of wake-up and discharge,the incidence of intraoperative respiratory depression,bradycardia,involuntary movement,irritating cough,hiccup,postoperative nausea,vomit and dysphoria of each group were recorded.Results Compared with that in Group A,the total amount of propofol,the time of wake-up and discharge,involuntary movement was less in Group B and C（P〈0.05）;compared with that in Group B,the former two were reduced（P〈0.05）,but there were no differences in the latter two in Group C（P〉0.05）;compared with that in Group A and B,the incidence of intraoperative respiratory depression and bradycardia were increaced,there were no differences in the rest in all the three groups（P〉0.05）.Conclusion Under BIS monitoring,the value of TCI remifentanyl and propofol in gastrointestinal endoscopy is to reach more reasonable depth of anesthesia which can reduce adverse responses,and to reach rapid recovery from anesthesia,though it needs special equipment and additional management of respiration and circulation.