不同靶浓度瑞芬太尼对丙泊酚闭环靶控输注稳定性的影响

Effect of different target concentrations of remifentanil on the stability of propofol closed-loop target control infusion

目的比较腹腔镜手术中不同靶浓度瑞芬太尼对丙泊酚闭环靶控输注稳定性的影响。方法选择腹腔镜手术患者86例,男23例,女63例,年龄18~60岁,BMI 18~25 kg/m^2,ASAⅠ或Ⅱ级,将患者随机分为三组:诱导及维持瑞芬太尼靶浓度2 ng/ml组(A组,n=28)、4 ng/ml组(B组,n=29)和6 ng/ml组(C组,n=29)。三组诱导时丙泊酚血浆靶浓度均为4μg/ml,当BIS降至75时开启丙泊酚闭环靶控输注,设定BIS目标值40~50。计算执行误差绝对中位数(MDAPE)、摆动度(Wobble)、总体分数(GS)、BIS优良时间占比。记录血管活性药物使用情况、闭环期间丙泊酚血浆靶浓度及术后恶心呕吐、呼吸抑制等不良反应的发生情况。结果与C组比较,A、B组GS明显升高(P<0.05),BIS优良时间占比明显降低(P<0.05),B组MDAPE明显升高(P<0.05),A组Wobble明显升高(P<0.05)。与A组比较,B、C组丙泊酚靶浓度明显降低(P<0.05)。三组术后恶心呕吐发生率差异无统计学意义。三组均未发生呼吸抑制。结论腹腔镜手术患者复合6 ng/ml靶浓度的瑞芬太尼时,丙泊酚BIS闭环系统稳定性最佳,且能维持良好的麻醉深度,血流动力学更稳定。

Objective To assess the effect of different target concentrations of remifentanil on the stability of propofol BIS closed-loop target control infusion and hemodynamics during laparoscopic surgery under general anesthesia.Methods Eighty-six patients undergoing laparoscopic surgery,23 males and 63 females,aged 18-60 years,BMI 18-25 kg/m^2,ASA physical statusⅠorⅡ,were randomly divided into three groups.The patients received a plasma target control of remifentanil at 2,4,6 ng/ml in group A(n=28),group B(n=29),and group C(n=29)during induction and maintenance of anesthesia.All patients received a plasma target control of propofol at 4μg/ml during induction of anesthesia.The closed-loop target control of propofol would open when BIS was below 75,and the BIS target value was set to 40-50.MDAPE,Wobble,GS,and the percentage of BIS maintained at 40-50 were calculated.The frequencies of vasoactive drug,the propofol plasma target concentration during closed-loop,and postoperative adverse reactions were recorded.Results The GS in group C was significantly lower than that in groups A and B(P<0.05),the ratio of excellent and good BIS in group C was significantly higher than that in groups A and B(P<0.05),the MDAPE of group C was significantly lower than that in group B(P<0.05),the Wobble in group C was significantly lower than that in group A(P<0.05).The propofol plasma target concentration in group A was significantly higher than that in groups B and C(P<0.05).There was no significant difference in the incidence of postoperative nausea and vomiting among the three groups.No respiratory depression occurred in the three groups.Conclusion In laparoscopic surgery,the patients with 6 ng/ml target concentration of remifentanil have had the best stability,maintained good anesthetic depth,reduced propofol dosage,and remained stable hemodynamics.