丙泊酚靶控输注Marsh模式和Schnider模式在妇科腹腔镜手术中应用的比较

The application of target controlled infusion with Propofol by Marsh model versus Schnider model during gynecological laparoscopic surgery

目的比较丙泊酚靶控输注Marsh模式和Schnider模式在妇科腹腔镜手术中的应用效果。方法选取2016年1~6月于深圳市南山区人民医院择期拟行妇科腹腔镜手术的患者100例,年龄18~55岁,ASA分级Ⅰ~Ⅱ级。采用随机数字表法将其分为两组(n=50):Marsh模式组(M组)和Schnider模式组(S组)。M组和S组分别采用丙泊酚靶控输注系统的Marsh模式和Schnider模式并复合瑞芬太尼进行麻醉的诱导和维持。记录患者的年龄、体重、麻醉时间、手术时间、意识消失时间、意识消失的效应室浓度(LOC),停药至苏醒时间、意识恢复的效应室浓度(ROC),停药至拔管时间;麻醉诱导前(T_0)、意识消失时(T_1)、插管前(T_2)、插管后(T_3)、切皮(T_4)、清醒(T_5)和拔管时(T_6)患者的心率,平均动脉压,BIS值;丙泊酚的麻醉总用药量和单位时间用药量;术毕及术后24 h询问患者是否存在术中知晓。结果两组患者意识消失时间和意识消失用药量比较差异无统计学意义(P>0.05);而麻醉中丙泊酚总用药量和单位时间用药量S组高于M组(P<0.05),停药至苏醒时间、停药至拔管时间S组长于M组(P<0.05)。与T_0比较,两组患者T_1、T_2、T_3、T_4、T_5、T_6HR与MAP差异无统计学意义(P>0.05);与M组比较,S组HR、MAP各时点差异无统计学意义(P>0.05)。S组BIS值在T_1、T_4、T_5、T_6时点低于M组(P<0.05)。两组均未发生术中知晓。M组Ce LOC与ROC呈正相关(P<0.05)。结论丙泊酚靶控输注麻醉在妇科腹腔镜手术中Marsh模式优于Schnider模式。

Objective To evaluate the applicability of target controlled infusion（TCI） with Propofol by March model and Schnider model during gynecological laparoscopic surgery. Methods One hundred unpremedicated patients（18 to 55 years, ASA Ⅰor Ⅱ） undergoing gynecologic laparoscopy in Shenzhen Nanshan People′s Hospital from Janurary to June 2016 were randomized into two groups（n=25 each） using a random number table ：group M and group S. Propofol was administered by TCI, with respectively March model and Schnider model in two groups, and combined with Remifentanil. The age, weight, anesthetic time, operative time, time for loss of consciousness, the corresponding amount of Propofol and effect site concentration of Propofol（Ce） at loss of consciousness（LOC） and Ce at recovery of consciousness（ROC）, time from discontinuation to analepsia, time from discontinuation to extubation, heart rate（HR）, mean arterial blood pressure（MAP） and bispectral index（BIS） were monitored and recorded before induction（T_0）, loss of consciousness（T_1）, before intubating（T_2）, after intubating（T_3）, skin incision（T_4）, consciousness（T_5）, extubation（T_6）, the total amount and unit time amount of Propofol. Intraoperative awareness was evaluated at 24 hours postoperation. Results There was no significant different in the time of lose consciousness and the amount of Propofol between group M and S（P〈0.05）. but The total amount and unit time amount of Propofol in group S were more than that in group M（P〈0.05）. The time from discontinuation to analepsia and the time from discontinuation to extubation of group S were both longer than group M（P〈0.05）. Compared with T_0,there were no significant different in HR, MAP at T_1,T_2, T_3, T_4, T_5 and T_6 in both groups（P〈0.05）. Compared with group M, there were no significant different in HR, MAP at T_0-6 in group S（P〈0.05）. There were no significant different in BIS at T_0, T_2, T_3 between the two groups,but at T_1, T_4, T_5, T_6 BIS in group S were lower than in group M（P〈0.05）. No intraoperative awareness happended. In group M Ce at LOC was positively correlated to Ce at ROC（P〈0.05）. Conclusion TCI with Propofol during gynecological laparoscopic surgery, Marsh model was better than Schnider model.