七氟醚对丙泊酚闭环靶控效果的影响

The effect of sevoflurane on propofol with closed 4oop target controlled infusion anesthesia system

目的 探讨静吸复合麻醉中七氟醚对闭环靶控输注丙泊酚调控麻醉深度效果的影响。 方法 60例ASA 分级Ⅰ、Ⅱ级择期行全身麻醉腹部手术患者，采用随机数字表法分为3组（每组20例）：单纯丙泊酚组（A组）、丙泊酚复合吸入0.6 MAC七氟醚组（B组）和丙泊酚复合吸入0.8 MAC七氟醚组（C组）。3组患者丙泊酚输注速率均由BIS介导的闭环靶控系统自动反馈调节。A组患者全程持续使用丙泊酚静脉麻醉；B组和C组应用丙泊酚维持20 min后开始吸入3%七氟醚，并根据各自MAC设定值调整吸入浓度，于吸入40 min后停止七氟醚；给药过程中连续观察靶控输注丙泊酚的血药浓度变化并做统计分析。 结果 B组和C组术中BIS与A组比较，差异无统计学意义（P〉0.05）。与A组比较，B组和C组丙泊酚血药浓度在七氟醚吸入后逐渐下降，停药后缓慢上升（P〈0.05）；吸入后30 min和40 min时，C组［（1.8±0.6），（1.2±0.4） mg/L］较B组［（1.9±0.6），（1.7±0.6） mg/L］与A组［（2.5±0.6），（2.5±0.6） mg/L］比较，血药浓度下降的更明显（P〈0.05）；组间丙泊酚血药浓度变化速度比较，C组比B组下降和上升的速度更快（P〈0.05），均于停止吸入后40 min趋于稳定。 结论 BIS闭环靶控丙泊酚麻醉系统在复合七氟醚0.8 MAC以内的状态下，可以有效地自动反馈调节麻醉深度。

Objective The primary goal was to determine the influence of sevoflurane on propofol with closed-loop target controlled infusion（TCI） delivery system in combined intravenous-inhalation anesthesia. Methods Sixty patients with ASA Ⅰ or Ⅱ were enrolled in this double-blinded study and randomly devided into three groups using the random number table method： group A, in which patients were only administrated propofol, group B and C, in which patients were given propofol for 20 min, followed with 0.6 MAC or 0.8 MAC sevoflurane for 40 min, respectively and the inhalation concentration was adjusted according to MAC. Serum propofol concentration was monitored continuouslyin. Results There was no difference in BIS among three groups （P〉0.05）. Serum concentration of propofol in group B and group C decreased constantly after the inhalation of sevoflurane but increased slowly when the inhalation was terminated（P〈0.05）, while it remained unchanged in group A. Compared with group A[（2.53±0.55）, （2.54±0.61） mg/L], the decline of serum concentration was more evident in group C[（1.81±0.63）, （1.24±0.4） mg/L] than group B[（1.92±0.58）, （1.67±0.64） mg/L] at 30 min and 40 min during the surgery. The changing rate in group C was higher than that of group B and became stable 40 min after the stop point of propofol. Conclusions The administration of propofol with closed-loop anesthesia delivery system could adjust the anesthesia depth automatically and effectively, when the sevoflurane was inhaled with the MAC under 0.8.