喉罩联合靶控和手控输注丙泊酚的临床观察

Clinical observation of target controlled and manually controlled propofol infusions with laryngeal mask airway

目的：应用喉罩和脑电双频指数（ BIS）监测,观察靶控输注和手控输注丙泊酚的临床效果。方法30例ASA Ⅰ～Ⅱ级乳腺癌患者拟在全麻下行乳腺改良根治术,随机分为靶控（ T组）和手控（ M组）组输注丙泊酚。 T组效应室靶浓度为6μg/mL,M组诱导剂量为2．5 mg/kg,初始维持速度5 mg/（ kg·h）,复合靶控输注效应室靶浓度为4 ng/mL瑞芬太尼。维持BIS值在40～60之间,维持平均动脉压（ MAP）在基础值的20%左右。比较两组用药量以及入室（T0）、诱导开始（T1）、置入喉罩即刻（T2）、置入完毕（T3）、切皮（T4）、停药（T5）、术毕（ T6）、睁眼（ T7）、自主呼吸恢复（ T8）、指令动作恢复（ T9）、拔除喉罩（ T10）各时刻MAP、心率（ HR）及BIS的变化。结果 T组丙泊酚用量高于M组（P=0．005）,瑞芬太尼用量差异无统计学意义（P〉0．05）；术中异常血压发生率差异无统计学意义（P〉0．05）；T4时,T组BIS值低于M组（39．80±9．62 vs.53．07±8．37,P=0．00）；T2、T3时,T组 MAP 均低于 M 组（P =0．002,P =0．009）；与 T1相比,T 组在 T2～T5时,MAP 明显降低（P 〈0．05）,T2～T7时,HR明显降低（P〈0．05）,T2～T10时,BIS值明显降低（P〈0．05）；M组在T3和T4时,MAP明显降低（P〈0．05）,T10时,HR明显升高（P〈0．05）,T2～T7时,BIS值明显降低（P〈0．05）。结论在BIS监测的麻醉深度下,TCI和MCI丙泊酚都能满足置入喉罩的麻醉需要,具有良好的可控性；与手控输注相比,喉罩联合靶控输注丙泊酚用量偏大,血流动力学波动较大,麻醉深度较确切。

Objective To compare the efficacy of laryngeal mask airway （ LMA） combined with propofol of target controlled infusion （ TCI） and manually controlled infusion （ MCI） ,under the monitoring on depth of anaesthesia by bispectral index （BIS）. Methods Thirty patients scheduled for modified radical mastectomy were randomly allo-cated as target controlled infusion group （group T） and manually controlled infusion group （group M）,group T re-ceived TCI propofol 6 μg/mL with LMA, while group M received the standard bolus of propofol 2. 5 mg/kg and 5 mg/（ kg·h） maintained,as well as the TCI remifentanil 4 ng/mL. The BIS was maintained 40～60 and the mean ar-terial pressure （ MAP） was within 20% of baseline. The drug consumption was recorded. The MAP,heart rate （ HR） , BIS score were compared at the time point of baseline （ T0 ） , induction （ T1 ） , insertion （ T2 ） , completing insertion （ T3 ） ,incision （ T4 ） ,withdrawal （ T5 ） ,end of operation （ T6 ） ,open eyes （ T7 ） ,spontaneously breath（ T8 ） ,instruction （ T9 ） ,extubation （ T10 ） between the two groups. Results There was no significant difference between the two groups in remifentanil doses. The propofol consumption in group T was more than that of group M （P〈0. 01）. There was no significant difference between the two groups in the incidence of abnormal MAP. The BIS score at T4 in group T was lower than that of group M （39. 80 ± 9. 62 vs. 53. 07 ± 8. 37,P〈0. 01）. The MAP at T2 and T3 in group T （66. 33 ± 11. 51,67. 13 ± 9. 16） were significantly lower than those of group M （82. 20 ± 14. 23,76. 00 ± 8. 13）,there were sig-nificant differences （P〈0.01）.In group T,compared with T1,the MAP was lower at T2 ～T5（P 〈0.05）,HR was lower at T2 ～T7（P〈0. 05）,BIS was lower at T2 ～T10（P〈0. 05）. In group M,compared with T1,the MAP was low-er at T3 and T4（P〈0. 05）,HR was higher at T10（P〈0. 05）,BIS was lower at T2 ～T7（P〈0. 05）. Conclusion Both TCI and MCI propofol administrations are associated with good controllability and could possibly satisfy the LMA in-sertion during BIS controlled on depth of anaesthesia. TCI cost more propofol than MCI with more variability in haemo-dynamics but precise depth of anesthesia during the procedure.