丙泊酚全自动闭环靶控输注全静脉麻醉在胃肠道肿瘤手术中的应用

Application of bispectral index feedback propofol closed-loop target controlled infusion in the gastrointestinal tumor operation under total intravenous anesthesia

目的观察丙泊酚闭环靶控输注以脑电双频指数（BIS）作为反馈指标在胃肠道肿瘤手术中的应用。方法拟在全凭静脉麻醉下进行胃肠道肿瘤手术的患者40例随机分为对照组（开环靶控组）20例与试验组（闭环靶控组）20例,观察2组患者在诱导前（T_0）、意识消失（T_1）、气管导管插入成功即刻（T_2）、气管插管成功后1 min（T_3）、切皮（T_4）、术中探查（T_5）、关闭腹膜（T_6）的平均动脉压（MAP）、心率（HR）、脑电双频指数（BIS）值、靶控泵调节频率、麻醉恢复情况等,并记录不良反应发生情况。结果与T_0比较,2组在T_1～T_6 MAP、BIS值均明显降低（P〈0.05）,HR在T_1,T_6明显降低（P〈0.05）。对照组在T_4,T_5 MAP升高较试验组显著（P〈0.05）,对照组在T_2,T_3,T_4,T_5 BIS值升高较试验组显著（P〈0.05）。在靶控泵平均调节频率方面,试验组显著高于对照组（P〈0.05）。麻醉结束后试验组的苏醒时间、拔管时间、定向力恢复时间较对照组明显缩短（P〈0.05）。2组在术后恶心、呕吐、寒战及术中知晓发生率差异无统计学意义（P〉0.05）。结论 BIS闭环靶控输注系统优于开环靶控输注,能使血流动力学及BIS值更加稳定,维持合理的麻醉深度,使术后麻醉苏醒与恢复更快。

Objective To discuss of the application of bispectral index（ BIS） feedback propofol closed- loop target controlled infusion in the gastrointestinal tumor operation. Methods Forty patients who were intended to gastrointestinal tumor operation under total intravenous anesthesia were randomly divided into two groups： treatment group： closed-loop target controlled（ CLTCI） and control group： open- loop target controlled（ OLTCI）. The mean arterial pressure（ MAP）,heart rate（ HR）,bispectral index（ BIS） in before anesthsia（ T_0）,consciousness disappear（ T_1）,endotracheal intubation（ T_2）,after endotracheal intubation 1 min（ T_3）,skin incision（ T_4）,intraoperative exploration（ T_5）,close peritoneum（ T_6） and regulating frequency of target controlled infusion pump,situation of anesthesia recover,and the incidence rate of adverse drug reactions were observed and compared. Results Compared with T_0,the MAP、BIS of two groups were reduced in T_1- T_6（ P〈 0. 05）. The HR was reduced in T_1 and T_6. Control group had a significantly higher level of MAP than those of treatment group（ P〈 0. 05）. The increase of BIS in T_2,T_3,T_4,T_5 was greater in control group than those in treatment group（ P〈 0. 05）. Treatment group was apparently higher than control group in regulating frequency of target controlled infusion pump. The opening eyes time,extubation time and orientation recovery time treatment group were shorter than those of control group（ P〈 0. 05）. There was no significant difference in the incidence of nausea and vomit,chill,intraopertive awareness between the two groups（ P〉 0. 05）. Conclusion BIS feedback propofol closed- loop target controlled infusion is superior to open- loop target controlled infusion,CLTCI can achieve more stable in haemodynamics and BIS,maintenance the reasonable anesthesia depth,accelerate the recovery quality after surgical.