闭环与开环靶控输注在妇科腔镜手术中的应用比较

Comparing Closed-and Open-loop Control Anesthesia Infusion in Gynecological Laparoscopic Operation

目的比较脑电双频指数(BIS)指导下丙泊酚复合瑞芬太尼闭环及开环靶控输注在妇科腹腔镜手术中的应用效果。方法选取中国医科大学附属盛京医院行择期妇科腹腔镜手术患者40例,随机分为闭环靶控组(Ⅰ组,n=19)及开环靶控组(Ⅱ组,n=21)。2组患者入室后常规监测各项生命体征及BIS,均采取静脉诱导方式,Ⅰ组根据BIS静脉输液泵自动反馈调节丙泊酚效应室浓度,Ⅱ组根据BIS手动调节丙泊酚效应室浓度。分别记录气腹前(T0)、气腹后5 min(T1)、气腹后15 min(T2)、气腹后30 min(T3)、排出气腹后10 min(T4)、离室(T5)的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度、BIS值,记录2组术后拔管时间及药物使用情况,同时进行Ramsay镇静评分并询问患者的主观舒适程度。结果Ⅰ组患者拔管时间少于Ⅱ组(P<0.01);Ⅰ组丙泊酚总使用量低于Ⅱ组(P<0.05),瑞芬太尼使用量2组对比差异无统计学意义(P>0.05);Ⅰ组患者HR较Ⅱ组更稳定,但MAP波动较大;拔管后Ramsay镇静评分2组无统计学差异,Ⅰ组主观舒适度好于Ⅱ组(P<0.05)。结论妇科腹腔镜手术中应用丙泊酚闭环靶控输注安全性高、可控性好、患者满意度高,且更节省药物,值得在临床上推广。

Objective To evaluate and compare the effectiveness of propofol-remifentanil closed-loop and open-loop anesthesia in gynecological laparoscopic operation under bispectral index （BIS） monitoring. Methods Forty female patients undergoing elective gynecological laparoscopic operation were recruited and randomly divided into closed-loop （group I ） and open-loop （group II ） groups. During anesthesia maintenance, the closed-loop group was administered with a BIS-feedback system to regulate the target effect-site concentration ; whereas, the open-loop group was administered the target effect-site concentration according BIS value manually. The variation of non-invasive mean arterial pressure （MAP）, heart rate （HR）, SpO2, BIS, extubation time, consumption of propofol and remifentanil, Ramsay index, and subjective comfort grade were recorded at the selected time points. Results The extubation time in group I was shorter than in group II. The total dosage of propofol administered in group I was less than that in group II , but there was no significant difference in the total consumption of remifentanil. HR in group I was steadier than in group II. However, the MAP and Ramsay index were similar in both the groups. The subjective comfort grade in group I was higher than in group II. Conclusion The use of propofol-remifentanil dosed-loop system by BIS-feedbaek anesthesia is safer, more controllable, with higher degree of satisfaction and sparing side-effects, we therefore recommend it during gynecological laparoseopie operations.