双水平气道正压无创通气应用于腹腔镜胆囊切除术全身麻醉用药费用评价

Cost analysis of general anesthesia using bi-level positive airway pressure ventilation for laparoscopiccholecystectomy

目的通过计算比较全身麻醉采用不同机械通气模式：双水平气道正压（BiPAP）面罩无创通气与气管内插管间歇正压通气（IPPV）（静脉麻醉与吸入麻醉）下的麻醉用药费用，探讨BiPAP通气在临床麻醉中的应用价值。方法择期行腹腔镜胆囊切除手术成年患者60例，完全随机分为3组，Ⅰ组（BiPAP无创通气组），术中输注丙泊酚维持麻醉；Ⅱ组（气管内插管机械通气组），术中输注丙泊酚维持麻醉；Ⅲ组（气管内插管机械通气组），术中吸入七氟醚维持麻醉。3组患者术中均应用舒芬太尼镇痛，顺式阿曲库铵维持肌松，根据麻醉深度指数（NI）监测镇静深度，将NI控制在50-60（脑电图分级NTS为D1级）。记录麻醉药消耗量、拔管时间以及恢复室停留时间。结果3组患者一般情况、麻醉时间、手术时间差异均无统计学意义。麻醉用药费用3组分别为Ⅰ组（360．5±90．7）元、Ⅱ组（502．4±81．2）元、Ⅲ组（441．0±99．3）元，3组间比较差异有统计学意义（P〈0．05）。各时间点生命体征及血气分析监测3组间差异均无统计学意义。结论BiPAP无创通气应用于腹腔镜胆囊切除术的全身麻醉下达到和气管内插管IPPV同样的通气效果，前者显著减少了麻醉的用药量，降低了麻醉用药费用。

Objective To compare the costs of non-invasive mask ventilation using bi-level positive airway pressure （BiPAP） and intermittent positive pressure ventilation （IPPV） via endotracheal intubation for general intravenous or endotracheal anesthesia, and to assess the clinical application of BiPAP mask ventilation for general anesthesia. Methods Sixty patients scheduled for elective laparoscopic cholecystectomy were complete randomly assigned into group I （BiPAP-NIPPV group, n=20） to receive propofol maintenance intravenous injection plus BiPAP ventilation, group Ⅱ （endotracheal intubation group, n=20） to be treated with propofol maintenance intravenous injection plus endotracheal intubation and group Ⅲ （endotracheal intubation group, n=20） to undergo sevoflurane maintenance inhaled anesthesia, respectively. Sufentanil and cisatracurium were applied for maintenance analgesia and muscle relaxation. Patients were monitored using narcotrend index （NI） to determine the degree of anesthesia, with a target range of between 50 and 60 corresponding to DTS grading of D1 for encephalogram. The consumption of anesthetics, time to extubation and length of stay in postanesthesia care unit were recorded. Results All the groups did differ statistically in terms of general conditions and duration of surgery and anesthesia （P〉0.05）. The cost of anesthetics was （360.5 ± 90.7） RMB in group I, （502.4 ± 81.2） RMB in group Ⅱ and （441.0 ± 99.3） RMB in group m （P〈0.05）, respectively. There was no significant difference in vital signs and arterial blood gas analysis at all time points among three groups （all P〉0.05）. Conclusion Short-term non-invasivemask ventilation using BiPAP for laparoscopic cholecystectomy is associated with lower consumption and cost of anesthetics, thus achieving equivalence as compared with endotracheal intubation using IPPV.