丙泊酚靶控输注Marsh模式和Schnider模式在宫腔镜手术中的应用比较

The application of target controlled infusion with propofol by Marsh model versus Schnider model during hysteroscopic surgery

目的比较丙泊酚靶控输注Marsh模式和Schnider模式在宫腔镜手术中的应用效果。方法选取2017年1月至2018年6月于中山大学孙逸仙纪念医院择期行宫腔镜手术患者60例,年龄20～60岁,BMI 18～30,ASA分级Ⅰ～Ⅱ级,分为两组,Marsh组(M组),n=30和Schnider组(S组),n=30。两组分别以Marsh模式和Schnider模式靶控输注丙泊酚进行麻醉,并用Narcotrend监测麻醉深度。记录手术时间、丙泊酚用量、术中体动次数、调整TCI参数次数、术中低血压次数、窦性心动过缓次数、辅助呼吸次数。采集基础状态(T_0)、意识消失(T_1)、扩张宫颈(T_2)、麻醉结束(T_3)时的NTI。并记录苏醒时间、恶心呕吐和寒战例数。结果M组和S组两组患者ASA分级、年龄、BMI、手术时间比较差异无统计学意义(P>0.05);M组单位时间丙泊酚用量少于S组,差异有统计学意义(P<0.01);M组患者术中体动次数多于S组,差异有统计学意义(P<0.05),术中调整TCI参数次数也多于S组,差异有统计学意义(P<0.01),但两组术中低血压、窦性心动过缓和辅助呼吸次数差异无统计学意义(P>0.05);基础状态(T_0)时,M组和S组两组NTI比较差异无统计学意义(P>0.05);在意识消失(T_1)和扩张宫颈(T_2)时,M组NTI高于S组,差异有统计学意义(P<0.01);在麻醉结束(T_3)时,M组和S组两组NTI比较差异无统计学意义(P>0.05);M组和S组两组患者苏醒时间、恶心呕吐和寒战例数比较差异无统计学意义(P>0.05)。结论宫腔镜手术中,丙泊酚Schnider靶控输注模式优于Marsh模式。

Objective To evaluate the applicability of target controlled infusion(TCI)with propofol by Marsh model and Schnider model during hysteroscopic surgery.Methods Sixty unpremedicated gynecologic patients,aged 20-60 yr,with body mass index of 18-30,American Society of Anesthesiologists physical status I or II undergoing hysteroscopic surgery in SunYat-sen Memorial Hospital from January of 2017 to June of 2018 were divided into M and S groups(n=30 each).Propofol was administered by TCI,with respectively March model and Schnider model in two groups,and the depth of anesthesia was monitored by Narcotrend.The applicability of two models was evaluated by ASA status,age,BMI,operative time,propofol dosage per unit time,number of body movement,TCI parameter adjustment,hypotension,sinus bradycardia,assistant breathing during the operation.The Narcotrend index date in the time of basic state(T0),loss of consciousness(T1),expansion of cervical(T2),end of anesthesia(T3)were collected and analyzed.Also recovery time of consciousness,number of nausea and vomiting,chill were recorded.Results There was no significant difference in the ASA status,age,BMI,operative time between group M and group S(P>0.05).The propofol dosage per unit time in group M were less than group S(P<0.01),number of body movement in group M was more than group S(P<0.05),TCI parameter adjust-ment in group M was more than group S too(P<0.01),but hypotension,sinus bradycardia,assistant breathing during the operation have no significant difference between the two groups.There was no signifi-cant difference in NTI between group M and group S in T0(P>0.05),NTI were higher in group M than group S in T1 and T2(P<0.01),but no significant difference in T3 between the two groups(P>0.05).There was no significant difference in the recovery time of consciousness,number of nausea and vomit-ing,chill between group M and group S(P>0.05).Conclusion Schnider model was better than Marsh model in propofol TCI during hysteroscopic surgery.