丙泊酚闭环靶控输注在中老年患者气管插管与拔管反应中的应用

Application of closed-loop target-controlled infusion of propofol in intubation and extubation of elderly patients

目的探讨丙泊酚闭环靶控输注(Closed-loop target controlled infusion,CL-TCI)技术在中老年患者手术中抑制气管插管与拔管反应的应用价值。方法拟行开腹胃肠手术的患者40例,ASAⅠ~Ⅱ级,年龄55~70岁,男22例,女18例。40例患者随机分为2组,开环组(O组)和闭环组(C组),每组20例。O组采用常规TCI技术进行麻醉诱导与维持,丙泊酚初始浓度设为3μg/mL,C组采用CL-TCI技术,以BIS值45±5为反馈指标在麻醉诱导和维持中进行反馈控制。记录并比较两组术中MAP、HR、诱导时间(诱导开始到BIS值达到45±5)、诱导期和整个手术期间丙泊酚用量、手术时间、拔管时间以及拔管后VAS评分。结果两组患者在诱导前MAP和HR差异无统计学意义(P>0.05),在诱导后BIS值达到45±5时,MAP和HR均显著下降(P<0.05)。C组在插管和拔管后即刻以及之后3 min的MAP和HR稳定性比较中均好于O组(P<0.05)。C组在诱导期和整个手术期间丙泊酚用量及拔管时间均明显少于O组(P<0.05),但诱导时间长于O组(P<0.05),两组术后VAS评分比较差异无统计学意义(P>0.05)。结论在中老年患者开腹手术中,丙泊酚CL-TCI在气管插管和拔管期间循环功能稳定方面优于常规TCI,增加了麻醉的安全性。

Objective To evaluate the feasibility of propofol infusion by a closed-loop system for tracheal intubation and extubation in elderly patients. Methods Totally 40 patients（ ASAⅠ~Ⅱ grades, aged 55 ~ 70 years, 22 males and 18 females, requiring general anesthesia with tracheal intubation and extubation） scheduled for gastrointestinal surgery were randomized into two groups： opened-loop group（ group O） and closed-loop group（ group C）. In both groups, anesthesia was maintained with a propofol target-controlled infusion and the initial concentration of propofol was 3 μg/mL. Open-loop TCI,where propofol titration was performed manually guided by the Bispectral Index（ target BIS value 45 ± 5） was used in group O,while closed-loop TCI was used in group C. The MAP,HR, induction time, the consumption of propofol during induction and surgery,operation time,extubation time and postoperative VAS score were recorded in both groups. Results There was no significant difference in MAP and HR between the two groups（ P 0. 05）,while the MAP and HR decreased significantly when BIS reached 45 ± 5（ P 0. 05）. The stability of MAP and HR in group C during intubation and within 3 min after extubation was better than that of group O（ P 0. 05）. The consumption of propofol during induction and surgery and the time of extubation in group C were less than those of group O（ P 0. 05）,while the induction time was longer（ P 0. 05）. There was no significant difference in postoperative VAS score between the two groups（ P 0. 05）. Conclusion For elderly patients who underwent gastrointestinal surgery, closed-loop automated titration guided by Bispectral Index for propofol infusion is more stable and safer than conventional TCI.