脑电双频指数反馈闭环靶控输注系统静脉麻醉在肝硬化患者中的临床应用

Clinical application of bispectral index feedback closed-loop target controlled infusion systemfor intravenous anesthesia in patients with cirrhosis

目的肝硬化患者术中采用脑电双频指数(bispectral index,BIS)反馈闭环靶控输注系统静脉麻醉,观察其对麻醉用药量和苏醒质量、苏醒时间的影响。方法肝硬化门脉高压患者80例行脾切除,食道静脉横断手术,随机分为实验组和对照组各40例,2组均采用右美托咪定联合丙泊酚-瑞芬太尼全凭静脉麻醉行靶控输注BIS监测。实验组设定BIS值50为反馈控制变量,调控全麻药用量,对照组进行常规监测靶控输注,2组患者诱导前3 min均静脉推注咪唑安定0.05 mg/kg,舒芬太尼0.3μg/kg,诱导开始丙泊酚血浆浓度靶控输注,浓度设定为2.5μg/mL诱导。记录2组患者入室后(T0),诱导前(T1),插管时(T2),手术切皮时(T3)、手术30 min(T4)、手术结束(T5)、出室前(T6)各时间点平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR),拔管时间,苏醒时间,出室时间,丙泊酚、瑞芬太尼用药总量。结果实验组拔管时间,苏醒时间,出室时间明显低于对照组(P<0.01);2组患者手术开始30 min(T4)时MAP具有明显的差异(P<0.05);丙泊酚使用总量明显低于对照组(P<0.01)。结论肝硬化患者麻醉中使用BIS反馈闭环靶控输注系统的全麻用药更为精准,更加量化,减少麻醉药用量,改善麻醉苏醒质量,缩短苏醒时间。

Objective Using bispectral index(BIS)feedback closed-loop target controlled infusion intravenous anesthesia in patients with cirrhosis,in order to observe its effect on the dosage of anesthetics,awakening quality and recovery time.Methods Eighty patients with cirrhosis and portal hypertension,splenectomy and transesophageal transection were randomly divided into control group and observation group,and the patients were all received intravenous anesthesia with dexmedetomidine combined with propofol-remifentanil under the guidance of BIS monitoring.The observation group was received target-controlled infusion using BIS feedback regulation,and the BIS value of 50 was set as the feedback control variable.The control group was received routine monitoring target-controlled infusion.Intravenous injection of midazolam 0.05 mg/kg and sufentanil 0.3μg/kg 3 min before induction in both groups of patients.Propofol plasma concentration target-controlled infusion was set at a concentration of 2.5μg/mL during induction and adjusted according to the BIS during induction and maintenance period.Mean arterial pressure(MAP),heart rate(HR),extubation time,wake time,out of the operating room time,total propofol and remifentanil medication were recorded during into the operating room(T0),pre-induction(T1),intubation(T2),surgical incision(T3),30 minutes of surgery(T4),operation end(T5)and out of the operating room(T6)in two groups of patients.Results The extubation time,recovery time and departure time in the observation group were significantly lower than those in the control group(P<0.01).There was a significant difference in MAP between the two groups at 30 minutes of surgery(T4)(P<0.05).The total amount of propofol used in the observation group was significantly lower than that of the control group(P<0.01).Conclusion BIS monitoring in anesthesia can guide the use of anesthetics,which can make the patients with cirrhosis more accurate and quantified in general anesthesia,so as to decrease the dosage of anesthetics,improve the recovery quality and shorten the wake time.