丙泊酚闭环靶控输注麻醉用于学龄前及学龄患儿体表手术的效果

Efficacy of closed-loop infusion of propofol for surgery on body surface in preschool and school-age pediatric patients

目的 评价丙泊酚闭环靶控输注麻醉用于学龄前及学龄患儿体表手术的效果.方法 择期行体表手术患儿,性别不限,ASA分级Ⅰ级.学龄前（3-6岁）患儿124例,采用随机数字表法分为2组（n=62）：闭环组（CPRE）和开环组（OPRE）.学龄（7-12岁）患儿38例,采用随机数字表法分为2组（n=19）：闭环组（CSTU）和开环组（OSTU）.麻醉维持期,设定BIS目标值为50,C PRE组和CSTU组采取闭环模式,自动调整血浆靶浓度.OpRE组和OSTU组采取开环模式,人工调整血浆靶浓度.记录维持期充分麻醉时间比（BIS40-60％）和输注系统总体评分（GS）.记录丙泊酚用量、调整频率和BIS平均值.记录围术期试验系统相关并发症的发生情况.结果 与OPRE组比较,CPRE组丙泊酚用量、GS和BIS平均值降低,BIS40-60％升高（P〈0.05）,调整频率差异无统计学意义（P〉0.05）.与OSTU组比较,CSTU组GS降低,BIS40-60％升高（P〈0.05）,丙泊酚用量、BIS平均值和调整频率差异无统计学意义（P〉0.05）.与CPRE组比较,CSTU组丙泊酚用量和GS降低,BIS40-60％升高（P〈0.05）,BIS平均值和调整频率差异无统计学意义（P〉0.05）.除C STU组1例发生气道痉挛外,其余患儿均未见严重并发症发生.结论 对于学龄前及学龄患儿体表手术,丙泊酚闭环靶控输注麻醉安全有效,麻醉稳定性和精准性优于开环靶控输注;且用于学龄患儿的效果优于学龄前患儿.

Objective To evaluate the efficacy of closed-loop infusion of propofol for surgery on the body Surface in preschool and school-age pediatric patients.Methods American Society of Anesthesiologists physical status Ⅰ pediatric patients of both sexes,undergoing elective surgery on the body surface,were included in the study.One hundred twenty-four preschool pediatric patients （aged 3-6 yr） were divided into 2 groups （n=62 each） using a random number table：closed-loop group （CPRE group） and openloop group （OPRE group）.Thirty-eight school-age pediatric patients （aged 7-12 yr） were divided into 2 groups （n=19 each） using a random number table：closed-loop group （CSTU group） and open-loop group （OSTU group）.The target bispectral index （BIS） value was set at 50 during maintenance of anesthesia.Propofol was delivered using closed-loop anesthesia delivery system,and the target plasma concentration of propofol was automatically regulated in CpRE and CSTU groups.Propofol was given using open-loop anesthesia delivery system,and the target plasma concentration of propofol was manually regulated in OpRE and OSTU groups.The adequate anesthesia time ratio （BIS40-60%） and global score （GS） of the delivery system were recorded during maintenance of anesthesia.The consumption of propofol,frequency of regulation and mean BIS value were recorded.The delivery system-related complications were recorded during the perioperative period.Results Compared with group OpRE,the consumption of propofol,GS and mean BIS value were significantly decreased,BIS40-60% was increased （P〈0.05）,and no significant change was found in the frequency of regulation in group CpRE （P〉0.05）.Compared with group OSTU,GS was significantly decreased,BIS40-60% was increased （P〈0.05）,and no significant change was found in the consumption of propofol,mean BIS value or frequency of regulation in group CSTU （P〉0.05）.Compared with group CpRE,the consumption of propofol and GS were significantly decreased,BIS40-60% was increased （P〈0.05）.and no significant change was found in the mean BIS value or frequency of regulation in group CSTU （P〉0.05）.One pediatric patient in group CSTU developed airway spasm,and no severe complications were found in the other pediatric patients.Conclusion For surgery on the body surface in preschool and school-age pediatric patients,closed-loop infusion of propofol is safe and effective,the stability and precision of anesthesia is superior to that of open-loop anesthesia delivery system,and it provides better efficacy in school-age pediatric patients than in preschool pediatric patients.