丙泊酚闭环靶控输注系统在小儿耳鼻喉手术中的应用

Application of Propfol Closed-loop Anesthesia System in Pediatric Otorhinolaryngologic Surgery

目的评估小儿耳鼻喉手术中脑电双频指数(BIS)指导下丙泊酚复合瑞芬太尼全凭静脉闭环与开环的效果。方法选择择期行小儿扁桃体腺样体切除小儿患者40例,随机分为闭环组(T组)和开环组(C组),每组20例。2组患者均采用静脉诱导方式,诱导后T组采用系统自动调节血浆靶控浓度方式,C组采用根据术中BIS值人工调节血浆靶控浓度方式。分别于麻醉前(T0)、插管即刻(T1)、插管后5 min(T2)、10 min(T3)、15 min(T4)、30 min(T5)、拔除气管插管(T6)各时间点记录无创血压、心率、脉搏血氧饱和度、心电图、BIS、人工调节丙泊酚靶控浓度的次数、苏醒时间。结果 T组患者丙泊酚应用总量小于C组患者,总体用量降低约9.83%;2组患者瑞芬太尼用量无统计学差异;BIS值波动及术中血流动力学方面,T组患者较C组稳定。结论小儿耳鼻喉手术中丙泊酚—瑞芬太尼闭环麻醉安全易行,可调控性强,应广泛使用。

Objective To evaluate the application of propfol-remifentanil closed-loop and opened-loop anesthesia in children otorhinolaryngologic operation under BIS monitoring. Methods Fourty children underwent elective children tonsillectomy and adenoidectomy were recruited for the study and randomly divided into two groups：closed-loop group（group T）and opened-loop group（group C）,with 20 children each. The two groups all received total intravenous induction,then the subjects of closed-loop group were administrated with a method of system automatic regulation of plasma target control and the opened-group cases underwent manual adjustment of plasma target control method according to the BIS value during operation. The variables of non-invasive blood pressure（BP）,heart rate（HR）,pulse oxygen saturation（Sp O2）,electrocardiogram（ECG）,bispectral index（BIS）,the number of times the manual adjustment of propfol target control applied,and recovery time,were recorded respectively at the time points of before anesthesia（T0）,immediately after intubation（T1）,5 min after intubation（T2）,10 min after（T3）,15 min after（T4）,30 min after（T5）and the removal of endotracheal intubation（T6）. Results The total dosage of propfol in group T was less than the dosage in group C with dosage decrease of 9.83%;there was no significant statistical difference of the total dosage of remifentanil. Conclusion The use of propfol-remifentanil closed-loop anesthesia in children otorhinolaryngologic operation is safe,easy,and of strong controllability,which should be widely promoted.