丙泊酚闭环靶控输注联合伤害敏感指数指导下的瑞芬太尼靶控输注在妇科腹腔镜手术中的应用

Application of closed-loop target controlled infusion(TCI )of propofol combined with pain and nociception index-guided remifentanil TCI in gynecological laparoscopic surgery

目的观察丙泊酚闭环靶控输注联合伤害敏感指数(IoC2)指导下的瑞芬太尼靶控输注在妇科腹腔镜手术中应用的效果。方法拟行腹腔镜下输卵管、卵巢和子宫手术患者48例,随机分为对照组和IoC2组,每组24例。两组均采用丙泊酚闭环靶控输注和瑞芬太尼靶控输注,IoC2组根据IoC2值调整瑞芬太尼血浆靶浓度,而对照组根据血流动力学水平调整。记录术中丙泊酚、瑞芬太尼的用量、术中循环波动的次数以及血管活性药物的使用次数;记录术毕苏醒时间、拔管时间、拔管后视觉模拟评分(VAS)以及拔管期间不良反应的发生率。结果与对照组相比较,IoC2组术中瑞芬太尼用量减少(P<0.05),低血压、心动过缓的发生率以及阿托品和麻黄碱的使用率降低(P<0.05),术后苏醒时间、拔管时间、拔管后VAS及拔管期间不良反应发生率无显著性差异(P>0.05)。结论丙泊酚闭环靶控输注联合IOC2指导下的瑞芬太尼靶控输注行妇科腹腔镜手术,能减少麻醉性镇痛药用量,更好地维持术中血流动力学平稳。

Objective To explore the effects of closed-loop target controlled infusion（TCI）of propofol combined with pain and nociception index（IoC2）-guided remifentanil TCI in gynecological laparoscopic surgery. Methods Forty-eight patients undergoing gynecological laparoscopic surgery were randomly divided into control group and IoC2 group（n = 24 in each group）. Closed-loop TCI of propofol combined with remifentanil TCI were performed in both groups. Remifentanil target plasma concentration was adjusted according to the IoC2 value in IoC2 group and the level of hemodynamics in control group. The dosage of intraoperative propofol and remifentanil,the number of intraoperative cycle fluctuations and frequency of vasoactive drugs were recorded. The recovery time after surgery,extubation time,the incidence of adverse reactions during extubation and visual analogue scale（VAS）after extubation were also recorded. Results Compared with control group,the intraoperative remifentanil dosage was decreased in IoC2 group（P 0. 05）,and the incidence of hypotension and bradycardia and the frequency of taking atropine and ephedrine in IoC2 group were also reduced（P 0. 05）. There was no difference in the recovery time,the extubation time,the pain score after extubation and the incidence of adverse reactions between the two groups（P 0. 05）. Conclusion The application of closed-loop TCI of propofol combined with IoC2-guided remifentanil TCI in gynecological laparoscopic surgery could reduce the dosage of narcotic analgesics and maintain the better intraoperative hemodynamic stability.