脑电双频指数监测下丙泊酚闭环靶控输注对妇科腹腔镜手术患者术中知晓和术后恢复的影响

Effect of closed-loop target-controlled infusion of propofol monitored by bispectral index on the intraoperative awareness and postoperative recovery in patients undergoing gynecological laparoscopic surgery

目的探讨脑电双频指数(BIS)监测下丙泊酚闭环靶控输注对妇科腹腔镜手术患者术中知晓和术后恢复的影响。方法选取60例行妇科腹腔镜手术的患者作为研究对象,将其随机分为对照组和观察组,各30例。观察组术中采用BIS监测下丙泊酚闭环靶控输注维持麻醉,对照组术中采用BIS监测下手动控制丙泊酚效应室浓度维持麻醉。比较两组患者不同时间点的BIS值、平均动脉压(MAP)、心率,以及患者术中知晓情况、术中丙泊酚用量、术后恢复情况及术后不良反应发生情况。结果两组患者的BIS值、心率差异均无统计学意义(均P>0.05),而两组患者的MAP差异有统计学意义(P<0.05);两组患者的BIS值、心率均有随时间变化的趋势(均P<0.05);分组与时间均无交互效应(均P>0.05)。两组患者的术中知晓情况及术后不良反应发生率比较,差异均无统计学意义(均P>0.05)。观察组术中丙泊酚用量及术后呼吸恢复时间、苏醒时间、指令反应恢复时间、拔管时间、离室时间均少于或短于对照组,术后语言等级评定量表评分、Ramsay镇静评分均低于对照组(均P<0.05)。结论在妇科腹腔镜手术中采用BIS监测下丙泊酚闭环靶控输注,可有效维持患者的麻醉深度,减少丙泊酚的总用量,避免患者术中知晓,促进患者术后恢复,安全可行。

Objective To investigate the effect of closed-loop target-controlled infusion of propofol monitored by bispectral index(BIS)on the intraoperative awareness and postoperative recovery in patients undergoing gynecological laparoscopic surgery.Methods A total of 60 patients undergoing gynecological laparoscopic surgery were selected,and they were randomly assigned to control group or observation group,with 30 cases in each group.Anesthesia was maintained by intraoperative closed-loop target-controlled infusion of propofol monitored by BIS in the observation group,and by intraoperative manual-controlled effect-site concentration of propofol monitored by BIS in the control group.The BIS values at various time points,mean arterial pressure(MAP),heart rate,as well as intraoperative awareness,intraoperative volume of propofol,postoperative recovery,and postoperative occurrence of complications were compared between the two groups.Results There was no significant difference in the BIS values and heart rate between the two groups(all P>0.05),whereas the MAP presented a statistically significant difference between the two groups(P<0.05).The BIS values and heart rate had a tendency to change over time(all P<0.05);moreover,there was no interaction effect between grouping and time(all P>0.05).There were no significant differences in the intraoperative awareness and incidence rate of postoperative complications between the two groups(all P>0.05).The observation group exhibited less intraoperative propofol volume,and shorter time to respiratory recovery,recovery,command response recovery,extubation,leave the recovery room,as well as lower scores of postoperative Verbal Rating Scale,Ramsay sedation as compared with the control group(all P<0.05).Conclusion Employing closed-loop target-controlled infusion of propofol monitored by BIS in gynecological laparoscopic surgery can effectively maintain the depth of anesthesia,decrease the total volume of propofol,prevent patients from intraoperative awareness,promote postoperative recovery of patients,which is safe and feasible.