脑电双频指数反馈闭环靶控输注在电子小肠镜检查中的应用

Application of electrical double frequency index feedback closed loop target control infusion in electronic enteroscopy

目的研究脑电双频指数(BIS)反馈闭环靶控输注(CL-TCI)在电子小肠镜检查中的应用效果。方法 60例需要小肠镜(经口)检查的患者随机均分为3组,A组以BIS作为控制变量的闭合环路靶控输注丙泊酚,结合开放环路靶控输注雷米芬太尼;B组靶控输注丙泊酚、雷米芬太尼;C组恒速输注丙泊酚、雷米芬太尼。检测麻醉前(T0)、入睡睫毛反射消失时(T1)、入镜即刻(T2)、小肠镜经过曲氏韧带(T3)、检查结束出镜后(T4)各组MAP、HR、SpO2、BIS,以及诱导时间、唤醒时间和定向力恢复时间,记录呼吸抑制、体动、呛咳等不良反应发生情况,记录丙泊酚各时段消耗量,电话随访有无术中知晓情况。结果 MAP、HR:与T0时间点比较,3组T1时均下降(P<0.05),T2、T3、T4时B组均低于A组(P均<0.05);C组T2、T3、T4时不稳定。BIS值:T2、T3、T4时B组均小于A组(P均<0.05);C组数值不稳定。诱导时间C组快于A、B组(P均<0.05),唤醒时间和离院时间A组快于B、C两组(P均<0.05)。A、B组均未发生呼吸抑制、体动、呛咳和术中知晓,C组呼吸抑制2例、体动4例。A组丙泊酚总消耗量少于B、C组(P均<0.05)。结论 BIS反馈下丙泊酚、雷米芬太尼CL-TCI应用于电子小肠镜检查,可使患者生命体征更平稳、丙泊酚用量减少、唤醒时间和定向力恢复时间缩短、留院时间缩短。

Objectve To investigate the application of electrical double frequency index （BIS） feedback closed loop target control infusion （CL-TCI） in electronic enteroscopy.Methods Sixty patients with enteroscopy （through the mouth） inspection were randomly divided into three groups：BIS as control variable of the closed loop CL-TCI propofol with open loop remifentanyl TCI group （group A）,target-controlled infusion propofol with remifentanyl （group B） and constant speed infusion propofol with remifentanyl group （group C）,20 cases in each group.The mean arterial pressure （MAP）,heart rate （HR）,pulse oxygenation （SpO2）,BIS,induction time,awakening time,orientation recovery time,and the adverse effects such as respiratory depression,body motion and bucking were recorded and compared,before anesthesia （T0）,disappearance of the eyelash reflex after sleeping （T1）,while the small intestine enteroscopy insertion （T2）,passingthrough the Treitz ligament （T3） and the end of examination after extraction （T4）.Results MAP,HR were declined at T1 time in all groups compared with T0 time point （P ＜ 0.05）.MAP,HR in group B were lower than group A （P ＜ 0.05） at T2,T3,T4 time points.The BIS value of group B was less than that in group A （P ＜ 0.05） at T2,T3,T4 time points,group C was instability.Induction time of group C was faster than that in group A and B （P ＜ 0.05） ; awakening time and departure time from hospital of group A were faster than these in group B and C （P ＜ 0.05）.Respiratory depression,body movement,cough and intraoperative awareness no found in group A and B; in C group,two patients appeared respiratory depression,four patients appeared body movement.Propofol consumption of group A was less than that in group B and C （P ＜ 0.05）.Conclusion BIS feedback CL-TCI of propofol and remifentanyl in the application of electronic enteroscopy made the vital signs more smoothly,the dosage of propofol less,recovery time,awakening time and departure time from hospital decrease.