CONCERT—CL闭环靶控输注系统在腹腔镜胃肠手术麻醉中的应用

Application of close-loop target control infusion system in anesthesia of laparoscopic gastrointestinal surgery

目的观察CONCERT-CL闭环靶控输注系统在腹腔镜胃肠手术麻醉中应用的可行性及安全性。方法选择ASA分级Ⅰ、Ⅱ级择期行腹腔镜胃癌或肠癌手术患者60例，采用随机数字表法分为闭环靶控输注组（A组）和经验组（B组），每组30例。记录两组患者手术相关情况：手术时间，麻醉时间，丙泊酚、瑞芬太尼、顺式阿曲库铵的用量，气管拔管时间，麻醉维持期手工调节麻醉药物的次数及血管活性药物使用次数；记录术中、术后副作用（术中体动反应、术中知晓、术后躁动及术后苏醒延迟发生例数）及术后镇静恢复情况；记录麻醉维持过程中Narcotrend分级监测（narcotrend index，NTI）值在40～60、〉60及〈40的时间所占比。结果A组气管拨管时间[（7．8±2．4）min]、丙泊酚用量[（13．2±2．8）mgks]，顺式阿曲库铵用量[（0．28±0．06）mg／kg]、手工调节麻醉药物次数（31次）均明显少于B组[分别为（12．2±3．6）min、（15．1±3．1）mg/kg、（0．34±0．10）mg／kg,80次]（P〈0．05）；在气管插管拔管后10min，A组警觉镇静（observer＇s assessment of alertness/sedation, OAA/S）评分[（4．6±0．4）分]明显高于B组[（3．7±0．6）分]（P〈0．05）；A组NTI在40～60的时间所占比[（81．4±4．8）％]明显高于B组[（59．6±8．2）％]（P〈0．05），而在〉60及〈40的时间所占比要明显小于B组（P〈0．05）。结论在腹腔镜胃肠手术麻醉维持中，CONCERT-CL闭环靶控输注方法安全、可靠，较传统开环的麻醉方法具有减少镇静及肌松药的用量、麻醉苏醒速度更快、质量更佳等优点，同时可减少麻醉过程中调节药物次数。

Objective To investigate the feasibility and safety of the close-loop target control infusion system in anesthesia of laparoscopic gastrointestinal. Methods Sixty ASA physical status I or II patients scheduled for laparoscopic gastrointestinal surgery into two groups （n=30）： close-loop target control infusion group （group A） and experienced group （group B）. Events in operation were recorded included surgery time, anesthesia time, the consumption of propofol, remifentanil, cisatracurium, extubation time, manually times of narcotic drug and vascular active drug in anesthesia maintenance. The adverse reactions of perioperation included the frequency of intraoperative body dynamic, intraoperative awareness, emergence agitation and delayed awakening were recorded. The postoperative observer＇s assessment of alertness/sedation （OAA/S） score was recorded. The percentage time narcotrend index （NTI） between 40 to 60 and percentage of time NTI〉60 and NTI〈40 were also recorded. Results In group A, the extubation time was （7.8±2.4） min, the consumption of propofol and cisatracurium were （13.2±2.8） mg/kg and （0.28±0.06） mg/kg respectively, the number of times of manually controlled narcotic drug delivery was 31. In group B, the extubation time was （12.2±3.6） rain, the consumption of propofol and cisatracurium were （15.1±3.1） mg/kg and （0.34±0.10） mg/kg respectively, the number of times of manually delivery narcotic drug was 80. Comparing with group B, they were significantly small in group A （P〈0.05）. The OAA/S score at ten minutes after extubation was （4.6±0.4） in group A, （3.7±0.6） in group B. It was significantly higher in group A than in group B （P〈0.05）. Compared with group B, the number of percentage time NTI between 40 and 60 was significantly high. The percentage numbers of time of NTI〉60 and NTI〈40 of group B were less in group A （P〈0.05）. The percentage number of time of NTI between 40 and 60 were （81.4±4.8）% in group A and （59.6±8.2）% in group B respectively. Conclusions The close-loop target control infusion system was safe and reliable in anesthesia of laparoscopic gastrointestinal. Comparing with the traditional method, it can reduce the dosage of sedation and muscle relaxants, achieve faster and better quality of the stage of analgesia and reduce the manually number of times of delivering narcotic drug.