熵指数监测指导丙泊酚联合瑞芬太尼靶控输注的临床研究

Clinical study of entropy index monitoring guiding propofol and remifentanil anesthesia by target-controlled infusion

目的探讨熵指数监测指导丙泊酚和瑞芬太尼靶控输注的可行性。方法择期腹腔镜下子宫切除术患者60例,随机分为靶控输注组(C组)和熵指数监测反馈指导组(F组),每组30例。2组患者均采用丙泊酚和瑞芬太尼双通道靶控输注,C组丙泊酚靶浓度设为3μg/mL,计算机根据药代动力学参数(Marsh程式)靶控输注,依据血流动力学变化调控瑞芬太尼靶控浓度;F组导依据熵指数值反馈调控。观察患者术中各时间监测点心率(HR)、平均动脉压(MAP)、反应熵(RE)和状态熵(SE)的变化,统计丙泊酚、瑞芬太尼和罗库溴铵的用量,记录术中血管活性药物的使用情况;比较2组患者手术时间、自主呼吸恢复时间、拔管时间和清醒时间;随访患者术后不良反应情况,进行患者满意度评分。结果与C组比较,F组患者术中各时间点HR、MAP更平稳,术中RE和SE波动幅度更小(P<0.05),丙泊酚和瑞芬太尼用量及血管活性药物的使用率明显减少,术毕拔管时间和清醒时间明显缩短(P<0.05);随访2组患者均无术中知晓、恶心呕吐等不良反应,差异无统计学意义(P>0.05);F组患者术后躁动发生率明显降低,患者满意度评分高于C组(P<0.05)。结论熵指数监测反馈调控丙泊酚和瑞芬太尼靶控输注在一定程度上达到了个体化按需麻醉的要求,提高了麻醉质量/价格比。

Objective To study the feasibility of propofol and remifentanil anesthesia with target-controlled infusion （TCI） controlled by feedback from entropy index monitoring. Methods Sixty patients scheduled for laparoscope uterus hysterectomy were equally randomized into two groups： TCI group （group C） and feedback TCI group （group F）. Both of anesthetic ways were two-path target controlled infusion of propofol and remifentanil. In group C, the target concentration of propofl was set to 3 μg/mL throughout anesthesia and regulated remifentanil on the basis of hemodynamic changes; In group F, the target concentration of propofol or remifentanil feed- back regulation was based on the entropy index value. To observe the changes of HR, MAP, RE and SE at every monitoring point during operations. Dosages of propofol, remifentanil, rocuronium and the use of vasoactive agents were recorded. The time of operation, autonomous respiration recovering, tube drawing and wake up were recorded. To observe adverse reactions after operations such as nausea, vomit, dysphoria and intraoperative awareness,and patients satisfaction were graded. Results Compared with group C, HR and MAP were more stable, RE and SE fluctuated less in group F （P〈0.05） ; The use of propofol, remifentanil and vasoactive agents was obviously lessened, time of tube drawing and wake-up was shortened （P〈0.05）. There were no intraoperative awareness in both groups. The difference of nausea and vomits in two groups has no statistical significance（P 〉0.05）. In group F, incidence rate of postoperative agitation was lessened （P〈0.05）. The satisfaction of patients was higher （P〈0.05）. Conclusion Entrophy index monitoring the depth of anesthesia can guide anesthetic drug use more accurately and individually, enhance the quality-price ratio of propofol and remifentanil administered by target-controlled infusion.