CSI监测对妇科腹腔镜患者七氟烷MACBAR的影响

Effect of CSI Monitoring on MACBAR of Sevoflurane in Gynecological Laparoscopy Patients

目的探讨CSI监测下七氟烷抑制50%妇科腹腔镜患者气腹诱发肾上腺素能反应的最低肺泡有效浓度(MACBAR)。方法方便选取2019年1—12月拟行妇科腹腔镜手术患者42例,年龄18-60岁,ASAⅠ或Ⅱ级,随机分为CSI组和对照组。患者入手术室后常规监测,CSI组加CSI监测。J静脉诱导气管插管吸入七氟烷稳定呼气末浓度超过15 min后开始气腹,观察气腹后血压、心率和CSI变化。按序贯法测定每组七氟烷MACBAR,血压、心率超过基础值20%,或CSI>60为阳性。结果两组间基本资料差异无统计学意义(P>0.05)。测定的CSI组七氟烷MACBAR为(1.44±0.21)%(95%CI=1.35%-1.54%),对照组七氟烷MACBAR为(1.76±0.38)%(95%CI=1.59%-1.94%),两组间比较差异有统计学意义(t=3.345,P<0.05)。结论在测定七氟烷的MACBAR中加入CSI监测,可以安全地保持更低浓度的七氟烷吸入浓度。

Objective To investigate the minimum alveolar effective concentration(MACBAR)of sevoflurane to inhibit adrenergic response induced by pneumoperitoneum in 50%of gynecological laparoscopic patients under CSI monitoring.Methods 42 patients who were conveniently selected to undergo gynecological laparoscopic surgery,from Janaury to December 2019 aged 18-60 years,with ASA I or II grade,were randomly divided into CSI group and control group.Routine monitoring of patients after entering the operating room,CSI group plus CSI monitoring.J intravenously induced endotracheal intubation to inhale the stable end-tidal concentration of sevoflurane for more than 15 minutes to start pneumoperitoneum,observe the changes of blood pressure,heart rate and CSI after pneumoperitoneum.The MACBAR of each group of sevoflurane was determined by sequential method,and the blood pressure and heart rate exceeded the basic value by 20%,or the CSI was greater than 60 as positive.Results There was no statistically significant difference in basic data between the two groups(P>0.05).The MACBAR of sevoflurane in the CSI group was(1.44±0.21)%(95%CI=1.35%-1.54%),and the MACBAR of sevoflurane in the control group was(1.76±0.38)%(95%CI=1.59%-1.94%),the difference between the two groups was statistically significant(t=3.345,P<0.05).Conclusion Adding CSI monitoring to the MACBAR for the determination of sevoflurane can safely maintain a lower concentration of sevoflurane inhalation.