右美托咪定对脑电双频指数监测下丙泊酚闭环靶控系统稳定性的影响

Effect of dexmedetomidine on the performance of bispectral index guided closed-loop target controlled infusion system for propofol administration

目的探讨右美托咪定在腹腔镜手术中对脑电双频指数(BIS)监测下丙泊酚闭环靶控系统(closed-loop target controlled infusion,CL-TCI)稳定性的影响。方法选择择期腹腔镜手术女性患者60例,年龄20～60岁,BMI 18～28kg/m^2,ASAⅠ或Ⅱ级,随机分为右美托咪定组(D组)和生理盐水组(S组),每组30例。麻醉诱导前10min D组泵入右美托咪定1μg/kg,10min内注射完毕;完毕后改为0.3μg·kg^(-1)·h^(-1)持续注射,S组泵入等量生理盐水。诱导完成后均由CL-TCI泵注丙泊酚,具体给药剂量由靶控系统根据BIS值自动调节,BIS目标值为45。根据术中连续记录的BIS值计算总体分数(GS)、误差绝对中位数(MDAPE)、摆动度(Wobble)。记录丙泊酚、瑞芬太尼药物用量以及血管活性药物使用例次。结果D组GS、MDAPE均明显高于S组(P<0.01),两组Wobble值差异无统计学意义;D组丙泊酚用量、麻黄碱使用次数明显少于S组(P<0.01),两组瑞芬太尼的用量差异无统计学意义。结论腹腔镜手术患者全身麻醉过程中使用右美托咪定联合BIS监测下CL-TCI能明显减少丙泊酚的用量,但会降低该系统的稳定性。

Objective To evaluate the effect of dexmedetomidine on the performance of closedloop target controlled infusion(CL-TCI)system for propofol administration guided by BIS in patients undergoing laparoscopic surgery.Methods Sixty female patients undergoing elective laparoscopic surgery,aged 20-60 years,BMI 18-28kg/m2,ASA physical statusⅠ orⅡ,were randomly divided into 2 groups:saline group(group S)and DEX group(group D),30 patients in each group.Before induction of anesthesia,dexmedetomidine 1μg/kg was administered within 10 minutes,then 0.3μg·kg^-1·h^-1 dexmedetomidine was continuously administrated during operation in group D.Group S was infused with an equal volume of saline.During the operation,both groups used CL-TCI to infuse propofol,the rate of propofol was adjusted by the CL-TCI system in order to maintain the target BIS of 45.Global score(GS),median absolute performance error(MDAPE),Wobble were figured out according to the continuously recorded BIS values to evaluate the performance of CL-TCI.The dosage of propofol,remifentanil and the number of times requiring vasoactive drugs were recorded.Results GS and MDAPE in group D was higher than those in group S(P < 0.01).There was no statistical difference in Wobble.The dose of propofol and times requiring ephedrine treatment in group D was significantly less than that of group S(P < 0.01).No difference was found in the dose of remifentanil between the two groups.Conclusion CL-TCI system combined with dexmedetomidine during general anesthesia for laparoscopic surgery can significantly reduce the dose of propofol,but reduce the performance of CL-TCI system.