靶控输注与间断静脉注射丙泊酚用于经皮微波消融治疗肝癌的麻醉效果比较

Comparison of target-controlled infusion and intermittent bolus injection of propofol in patients undergoing ultrasound-guided PMCT of hepatoma

目的比较肝癌患者在静脉麻醉下行超声引导下经皮微波消融治疗（PMCT）中,丙泊酚靶控输注（TCI）与间断静注的麻醉效果。方法选择肝功能正常或轻度异常拟行超声引导下PMCT的肝癌患者38例,年龄35～65岁,体质指数（BMI）18～28kg/m2,ASA Ⅰ~Ⅱ级,随机分为靶控输注组（T组,n=19）和间断静注组（I组,n=19）。两组患者在麻醉诱导前5min静滴芬太尼1.5μg/kg。T组诱导时丙泊酚血浆靶浓度设定为3μg/ml,术中根据患者体动及循环变化调节丙泊酚血浆靶浓度,每次增减0.2～0.5μg/ml,术毕前2min停止用药;I组诱导时静注丙泊酚1.5mg/kg,根据患者体动情况每次追加丙泊酚0.3～0.5mg/kg。记录患者诱导前即刻（T0）和诱导后入睡即刻（T1）的平均动脉压（MAP）、心率（HR）和脉搏血氧饱和度（SpO2）,术中呼吸抑制、体动反应情况,手术时间,苏醒时间,丙泊酚总用药量;记录T组患者苏醒时血药浓度。结果两组患者T0与T1的SpO2及其变化均无显著性差异,两组均未出现呼吸抑制;两组患者术前MAP和HR无显著差异;T组T1与T0的MAP变化比率（ΔMAP）明显小于I组[（12.81±6.27）%vs.（20.05±7.83）%,P〈0.01],两组T0与T1的HR变化比率（ΔHR）无显著性差异;T组体动反应发生率小于I组（52.63% vs.89.47%,P〈0.05）,体动发生次数明显少于I组（P〈0.01）;T组与I组丙泊酚单位时间用药量无显著性差异;苏醒时间T组较I组延长[（3.21±1.69）min vs.（2.26±1.10）min,P〈0.05]。结论丙泊酚靶控输注与间断静注均可安全用于肝癌超声引导下PMCT的静脉麻醉,而以靶控输注为优。丙泊酚靶控输注静脉麻醉使肝功能正常或轻度异常的肝癌患者术中循环更加稳定,体动反应更少。

Objective To compare the effect of target-controlled infusion and intermittent bolus injection of propofol for patients undergoing ultrasound-guided per-cutaneous microwave coagulation therapy（PMCT） for hepatoma with intravenous anesthesia.Methods Thirty-eight ASA Ⅰ ～ Ⅱ hepatoma patients undergoing ultrasound-guided PMCT were studied.Their age ranged from 35 to 65 years old and the BMI was 18～28 kg/m 2.Their liver function was normal or mildly abnormal（Child-Pugh Class A）.Patients were divided into two groups randomly,Group T（n=19） with target-controlled infusion and Goup I（n=19） with intermittent bolus injection.Before anesthesia induction,all patients received a single fentanyl bolus dose（1.5 μg /kg i.v.）.Patients in Group T（n=19） were induced with propofol TCI at a target concentration of 3 μg/ml,and increased or decreased 0.2～0.5 μg/ml according to patient＇s status and infusion was stopped two minutes before the end of surgery.Patients in Goup I were anaesthetized with propofol by intermittent bolus injection.1.5 mg/kg bolus of propofol was administered intravenously and 0.3～0.5 mg/kg bolus of propofol was administered according to patient＇s status.MAP,HR,SpO2 before induction（T0） and after induction（T1）,movement,duration of surgery,patients＇ awaken time,total dosage of propofol were recorded,and whether respiratory depression occurred were also observed for both groups.For Group T,propofol concentration in blood at the time of eye opening was also recorded.Results There was no significant difference in SpO2 variation between the two groups.No respiratory depression occurred in all patients.Changes in MAP（ΔMAP） between T0 and T1 of Group T were significantly lower than those in Group I（P 0.01）.Changes in HR（ΔHR） between T0 and T1 of the two groups were comparable.Movement occurrence of Group T was lower than Group I（P 0.05） and movement counts of Group T was also significantly less than Group I（P 0.01）.There was no significant difference in SpO2 on dose intensity of propofol between the two groups.Awaken time was significantly prolonged in the Group T（P 0.05）.Conclusions Both TCI and intermittent bolus injection of propofol can be used in ultrasound-guided PMCT safely.While target-controlled infusion can decrease the changes of hemodynamics and reduce the movement which will improve the safety of surgery comparing with intermittent bolus injection.For hepatoma patients with normal or mildly abnormal liver function,we prefer the TCI of propofol in ultrasound-guided PMCT with intravenous anesthesia.