BIS指导下丙泊酚维持麻醉在取石困难胆总管结石患者ESWL中的应用

目的探讨脑电双频指数(BIS)指导下丙泊酚维持麻醉用于取石困难胆总管结石患者体外冲击波碎石(ESWL)中对围术期血流动力学和不良反应的影响。方法选取拟行体外冲击波碎石的取石困难胆总管结石患者127例为观察对象,按随机数字表法分为观察组(n=64)和对照组(n=63)。麻醉诱导后丙泊酚基础维持量设置为3mg/(kg·h),观察组调节丙泊酚用量使BIS值保持在(60±5);对照组由麻醉医师根据临床经验,按患者体动反应及检查时长调节丙泊酚用量。分别观察患者麻醉前(T0)、诱导5min后(T1)、开始碎石时(T2)、碎石结束时(T3)生命体征;记录两组ESWL时间、丙泊酚总量以及苏醒时间;同时记录患者术中体动、呼吸抑制、低血压(低于基础平均动脉压20%)、低氧血症(SpO2<95%)等不良事件例数。结果两组患者的平均动脉压(MAP)、心率(HR)、不同时刻、组间和交互方面比较差异均有统计学意义(P<0.05)。除T1与T3外,对照组组内每两个时间点比较差异均有统计学意义(P<0.05),但观察组组内每两个时间点比较差异均无统计学意义(P>0.05),且除T0外,观察组的MAP、HR均明显高于对照组(P<0.05)。观察组丙泊酚总量以及体动、低血压等不良反应发生率均低于对照组(P<0.05),且ESWL总时长、术后苏醒时间均短于对照组(P<0.05)。结论取石困难胆总管结石患者ESWL治疗过程中,与传统凭经验输注比较,BIS指导下丙泊酚输注在维持血流动力学稳定、缩短苏醒时间、减少丙泊酚总用量、降低术中体动等不良反应发生率等方面存在优势。

Objective To investigate the effects of propofol maintenance anesthesia under the guidance of BIS(bispectral index)on extracorporeal shock wave lithotripsy in patients with difficult bile duct stones for perioperative hemodynamics and adverse events.Methods A total of 27 patients with choledocholithiasis who had planned extracorporeal shock wave lithotripsy in Hangzhou First People's Hospital afliated to Zhejiang University School of Medicine were selected as the research subjects.Random number table method was divided into observation group(n=64)and control group(n=63).After the induction of anesthesia,the basic maintenance amount of propofol was set to 3mg/kg/h.In the observation group,the dosage of propofol was adjusted to keep the BIS value at(60+5);in the control group,the dosage of propofol was adjusted according to the patient's body movement response and examination duration according to clinical experience.The vital signs of the patients were observed before anesthesia(TO),after 5 minutes of induction(T1),at the beginning of lithotripsy(T2),at the end of lithotripsy(T3);and the ESWL time,the total amount of propofol and the recovery time of the two groups were recorded.The number of adverse events such as body movement,respiratory depression,hypotension(the change range exceeded the basic mean arterial pressure by 20%)and hypoxemia(SpO2<95%)were recorded during the operation.Results The mean arterial pressure(MAP)and heart rate(HR)were statistically different between different time points,groups and interactions(P<0.05).Excepted for TI and T3,the difference between the two control points in the control group was satistically significant(P<0.05),but the difference between the two observation points in the observation group was not statistically significant(P>0.05).In addition to T0,the MAP and HR of the observation group were significantly higher than those of the control group(P<0.05).The total propofol,body movement,hypotension and other adverse events in the observation group were lower than those in the control group(P<0.05),and the total duration of ESWL and postoperative recovery time were shorter than those in the control group(P<0.05).Conclusion Compared with traditional empirical infusion in ESWL treatment of patients with choledocholithiasis,propofol infusion under the guidance of BIS has advantages in maintaining hemodynamic stability,shortening recovery time,reducing the total dosage of propofol,and reducing the incidence of intraoperative adverse events such as body movement.