丙泊酚闭环靶控输注用于腹腔镜胆囊切除手术20例

Closed-loop Titration of Propofol for General Anaesthesia in 20 Cases of the Laparoscopic Cholecystectomy

目的探讨以脑电双频指数（BIS）为反馈控制变量的丙泊酚闭环靶控输注系统复合瑞芬太尼全凭静脉麻醉用于腹腔镜胆囊切除术的可行性。方法择期行腹腔镜胆囊切除手术患者40例，按照随机数字表法分为治疗组和对照组各20例，治疗组采用闭环靶控，设置反馈值为BIS45～55；对照组采用开环靶控，诱导时丙泊酚血浆靶控浓度设定为4μg·mL^-1，麻醉维持时丙泊酚血浆靶控浓度设定为2～5μg·mL^-1（根据BIS反馈值45～55人工调整）。诱导时两组瑞芬太尼以4ng·mL^-1靶控输注，麻醉维持时根据手术中情况调整瑞芬太尼用量。记录两组在诱导前（t0）、靶控输注BIS值为50时（t1）、插管时（t2）、切皮时（t3）、手术开始5min（t4）、切除胆囊时（t5）、缝皮时（t6）的平均动脉压（MAP）、心率（HR）、BIS变化、诱导时间及丙泊酚用量。结果对照组在t1、t3、t4、t5等时间点MAP较治疗组均明显下降（均P〈0．05）；t5时间点HR变化较大（P〈0．05）。治疗组和对照组在t2时间点丙泊酚用量分别为（110．10±8．34），（120．55±6．26）mg：在t5时间点丙泊酚用量分别为（603．20±116．55），（759．50±116．37）mg（均P〈0．05）。结论以BIS为反馈值．丙泊酚闭环靶控输注复合瑞芬太尼全凭静脉麻醉用于腹腔镜胆囊切除手术，手术中患者麻醉深度易于维持，血流动力学稳定．丙泊酚用量明显减少。

Objective To evaluate the feasibility of propofol infusion by a closed-loop system for the titration of anaesthetic in laparoscopic cholecystectomy guided by Bispectral Index( BIS). Methods Forty patients subjected to laparoscopic cholecystectomy randomly allocated into two groups: the control group with opened-loop titratioin of propofol TCI induced at a target of 4 μg·m L-1and aintained from 2 to 5 μg·m L-1and the treatment group with closed-loop titration was performed using a proportional differential algorithm.For both groups,the BIS was set at 45-55.Remifentanil TCI was infused at a target of 4 ng·m L-1and was maintained according to the situation. The change in medial arterial pressure( MAP),heart rate( HR) and BIS were recorded before anesthesia( t0),target BIS of 50( t1),at tracheal intubation( t2),during incision of skin( t3),5 min after the operation( t4),at t5 of gallbladder removing and at t6 of skin suturing.The dose of propofol was calculated.Results Haemodynamic data were similar between groups during the induction.But MAP was decreased significantly at t1,t3,t4,t5 in the control compared with the treatment group( P<0.05).HR changes a lot at t5 in the control compared with the treatment( P<0.05).Total dose of propofol in the treatment group was statistically lower than that in the controls[( 110.10± 8.34) vs( 120.55±6.26) mg;( 603.20±116.55) vs( 759.50±116.37) mg,P<0.05) ]. Conclusion Automated titration guided by BIS for propofol infusion is feasible without increase in haemodynamic adverse effects and is of less propofol consumption in the laparoscopic cholecystectomy.