脑电双频谱指数反馈调控异丙酚靶控输注静脉麻醉

Propofol anesthesia with target-controlled-infusion controlled by feedback from BIS

目的 评价BIS作为异丙酚靶控输注的反馈控制变量在腹腔镜胆囊切除术麻醉中的可行性。方法 40例行择期腹腔镜手术的病人随机分为两组,反馈靶控输注组和靶控输注组,每组20人。BIS作为反馈控制变量设定在50。诱导前3min一次性静注芬太尼3μg,异丙酚的血浆靶浓度设定为3μg/ml,诱导及维持期间保持不变。记录并比较两组间的实时BIS值、术中收缩压和舒张压的最高值和最低值、附加药物剂量、呼唤睁眼反应恢复和定向力恢复时间、术中知晓情况和异丙酚的单位标准化使用剂量。结果 反馈组的异丙酚总剂量低于靶控组（P<0.01）,单位标准化剂量亦较低（P<0.01）,血液动力学相对稳定,所用升压药少（P<0.01）,停药后呼唤反应恢复时间较短（P<0.05）,但定向力恢复时间两组间无统计学差异（P>0.05）。术中BIS的最高值、最低值及清醒值、定向力恢复时的数值,两组间无统计学差异（P>0.05）。芬太尼均可以使反馈输注组BIS值和靶控输注组BIS值显著下降（P<0.01）。结论BIS作为异丙酚靶控输注麻醉的反馈控制变量是可行的,具有这种特性的输注系统能够满足腹腔镜胆囊切除手术的麻醉要求,具有异丙酚用药量少、苏醒快、术中血压比较稳定的优点,使得麻醉深度的调控更加精确。由于不同药物对BIS的影响不同,BIS作为麻醉深度监测指标?

Objective Target-controlIed-infusion(TCI) system makes administration of intravenous anesthetics simpler, more accurate and adjustable. Bispectral index (BIS) is generally accepted as a measurement of depth of sedation and anesthesia. The aim of this study was to evaluate the usefulness of BIS as a feedback control in propofol anesthesia with TCI for patients undergoing laparoscopic cholecystectomy. Methods Forty ASA Ⅰ - Ⅱ patients (12 male, 28 female) aged between 20-70 yr were randomly allocated to one of two groups of twenty each: feedback TCI group and TCI group. In feedback TCI group, BIS value of 50 was set as the control variable. A bolus of 3 μg·kg-1 fentanyl was given Ⅳ 3 min before induction. The target concentration of propofol was set at 3 μg·ml-1 throughout anesthesia. Real time BIS, the highest and lowest systolic and diastolic pressure during operation, doses of adjunctive drugs, time for emergence and orientation, awareness during operation and the standardized unit dose of propofol were recorded and compared between groups. Results Total dose of propofol was statistically lower in the feedback TCI group than that in TCI group(P< 0.01) , same was the standardized unit dose of propofol( P < 0.01) . Better hemodynamic stability was achieved in feedback TCI group with less vasoconstrictors used during operation. Furthermore time for emergence after discontinuation of infusion was significantly shorter in feedback TCI group than that in TCI group, but there was no significantly difference in time for regaining orientation between the two groups. The highest and the lowest values of BIS during operation, the BIS values at emergence and at regaining orientation were not significantly different between the two groups. Fentanyl decreased BIS significantly in both groups. Conclusions BIS used as a feedback control is useful in propofol anesthesia with TCI. Propofol anesthesia with TCI controlledby feedback from BIS for laparoscopic cholecystectomy has the advantages of less propofol, rapid emergence, more stable blood pressure and more accurate adjustment of depth of anesthesia.