丙泊酚靶控输注在全胸腔镜二尖瓣置换术中的应用

The application of propofol target controlled infusion in the total thoracoscopic mitral valve replacement

目的观察丙泊酚靶控输注(TCI)在全胸腔镜二尖瓣置换术中的使用效果及安全性。方法将110例ASA IIIII级风湿性二尖瓣病变拟在全胸腔镜下行择期二尖瓣置换术的患者随机分为TCI组和N-TCI(非TCI)组,每组55例。TCI组使用丙泊酚靶控输注进行麻醉诱导与维持,N-TCI组使用丙泊酚单次推注进行麻醉诱导,丙泊酚持续输注及大剂量镇静镇痛进行麻醉维持。观察两组患者诱导期间低血压发生率,记录患者基础情况、麻醉诱导期血管活性药物用量、麻醉诱导期和维持期丙泊酚用量、手术时间、体外循环时间、升主动脉阻断时间、清醒时间、机械通气时间、拔管时间、ICU停留时间以及术后并发症情况等临床参数。结果 TCI组患者麻醉诱导期低血压发生率(21.8%vs45.5%,P=0.007)、诱导期及维持期丙泊酚用量均明显低于N-TCI组[(62.3±17.7)mgvs(85.9±24.4)mg,P=0.002]及[(640.8±159.7)mgvs(843.5±283.7)mg,P=0.001],清醒时间[(1.9±0.6)hvs(3.3±0.9)h,P=0.011]、机械通气时间[(11.1±6.8)hvs(15.9±8.2)h,P=0.024]、拔管时间[(11.7±6.9)hvs(16.5±8.3)h,P=0.028]明显短于N-TCI组,术后院内肺部感染发生率(0vs7.3%,P=0.049)明显低于N-TCI组。两组患者其他参数差异无明显统计学意义。结论丙泊酚靶控输注能安全应用于全胸腔镜二尖瓣置换术,有利于维持围术期血流动力学平稳,患者术后恢复时间明显缩短,术后肺部并发症发生率极大降低。

Objective To observe the safety and efficacy of the propofol target controlled infusion in the total thoracoscopic mi-tral valve replacement.Methods A hundred and tenpatients with ASA grade II- III rheumatic mitral valve disease for total thoraco-scopic mitral valve replacement were randomly assigned to TCI group and N- TCI group, 55 cases in each group. In TCI group,propo-fol target controlled infusionwas used for induction and maintenance, and N- TCI group propofol single injection was for induction andcontinuous infusion for maintenance. Both groups used high dose sedative analgesics under extracorporeal circulation for total thoraco-scopic mitral valve replacement. Observed changes in the incidence of hypotension during the induction phase, the basic clinical param-eters of patients, the dosage of vasopressors and propofol during induction and maintance, the operation time, CPB time, clampingtime, awake time, mechanical ventilation time, extubation time, ICU stay time and postoperative complications in both groups were re-corded.Results The incidence of hypotension during induction in TCI group was significantlylower than N-TCI group（21.8%vs45.5%,P = 0.007）. The dosage of propofol during the induction and maintaince period in TCI group were less than N-TCI group（（62.3±17.7）mgvs（85.9±24.4）mg,（P = 0.002）, and（640.8±159.7）mgvs（843.5±283.7）mg,（P = 0.001））.The awake time（（1.9±0.6）hvs（3.3±0.9）h,（P = 0.011））, mechanical ventilation time（（11.1±6.8）hvs（15.9±8.2）h,（P = 0.024）） and extubation time（（11.7±6.9）hvs（16.5±8.3）h,（P = 0.028）） in TCI group were significantly shorter than N- TCI group. The incidence of postoper-ative lung infection in hospital in TCI group was lower than N-TCI group（0 vs 7.3%,P = 0.049）.Conclusion Propofol target con-trolled infusion can be safely used in total thoracoscopic mitral valve replacement.It can maintain stable hemodynamics, shorten postop-erative recovery time and reduce postoperative lung infection obviously.