手术体积描记指数联合熵指数在腹腔镜胆囊切除术中的监测分析

Application analysis of SPI combined with entropy index monitoring in laparoscopic cholecystectomy

目的:探讨手术体积描记指数(SPI)联合熵指数监测在腹腔镜胆囊切除术中指导麻醉药物使用的有效性。方法:选取医院收治的60例行腹腔镜胆囊切除术患者,采用随机数表法将其分为SPI监测组和对照组,每组30例;SPI监测组使用SPI监测和调节瑞芬太尼靶浓度,对照组根据术中血压及心率变化调节瑞芬太尼靶浓度,两组均采用状态熵(SE)监测指导调节丙泊酚靶浓度。记录麻醉诱导前(T0)、麻醉诱导后(T1)、气管插管时(T2)、手术切皮时(T3),建立气腹时(T4)、气腹结束时(T5)及气管拔管时(T6)各时间点对应的心率(HR)、平均动脉压(MAP)及SE值;记录麻醉时间、手术时间、睁眼时间、拔管时间、瑞芬太尼、丙泊酚用量、术中不良事件及术后并发症。结果:SPI监测组和对照组患者组内T 2、T 4及T6时的MAP、HR及SE值相较于T1均明显升高,差异有统计学意义(F_(MAP)=51.657,F=139.851;F_(HR)=90.639,F=81.242;F_(SE)=621.169,F=592.110;P<0.05);SPI监测组T0~T6各时点的SPI值均较T0明显降低,差异有统计学意义(F=290.341,P<0.05)。SPI监测组瑞芬太尼及丙泊酚的用量与对照组相比明显降低,睁眼时间及拔管时间明显缩短,其差异有统计学意义(t=2.384,t=2.155,t=3.701,t=5.272;P<0.05)。SPI监测组术中出现高血压、低血压及心动过速等不良事件的发生率低于对照组,血流动力学波动幅度小于对照组,其差异均有统计学意义(x^(2)=4.800,x^(2)=4.022,x^(2)=5.079;P<0.05)。结论:SPI联合熵指数监测指导腹腔镜胆囊切除术中麻醉用药,可有效减少术中瑞芬太尼和丙泊酚的用量,血流动力学更加稳定,恢复时间更快。

Objective:To investigate the effectiveness of surgical plethysmography index(SPI)combined with entropy index monitoring in guiding the use of anesthetic drug during laparoscopic cholecystectomy.Methods:Sixty patients underwent laparoscopic cholecystectomy were selected,and they were divided into SPI group and control group,with 30 cases in each group.The SPI group used SPI to monitor and adjust remifentanil target concentration,and the control group adjusted the remifentanil target concentration according to the changes of blood pressure and heart rate during the surgery.Both two groups used state entropy(SE)to monitor and guide the adjustment of the propofol target concentration.The heart rate(HR),mean arterial pressure(MAP)and SE values at each time point,which included pre induction of anesthesia(T0),post induction of anesthesia(T1),during endotracheal intubation(T2),during surgical skin incision(T3),when establishing pneumoperitoneum(T4),when completing pneumoperitoneum(T5),and during endotracheal extubation(T6),were recorded.In addition,the anesthesia time,surgical time,eye-opening time,extubation time,dosages of remifentanil and propofol,the intraoperative adverse events and postoperative complications were also recorded.Results:The MAP,HR and SE values of two groups at T2,T4,and T6 were significantly higher than those at T1,with statistically significant differences(F_(MAP)=51.657,F=139.851,F_(HR)=90.639,F=81.242,F_(SE)=621.169,F=592.110,P<0.05).The SPI values at each time point in the SPI group at T0 to T6 were significantly lower than those at T0,with statistically significant difference(F=290.341,P<0.05),respectively.Compared with those of the control group,the dosages of remifentanil and propofol in the SPI group significantly reduced(t=2.384,t=2.155,P<0.05),and the eye-opening time and extubation time of the SPI group significantly were shortened(t=3.701,t=5.272,P<0.05),respectively.Compared with those in the control group,the incidences of adverse events included hypertension,hypotension and tachycardia during surgery were lower in the SPI group,and the amplitude of hemodynamic fluctuation was smaller,with statistically significant(x^(2)_(MAP)=4.800,x^(2)=4.022,x^(2) HR=5.079,P<0.05),respectively.Conclusion:SPI combined with entropy index monitoring can effectively guide the intraoperative anesthesia medication,and reduce the intraoperative dosages of remifentanil and propofol,which hemodynamics is more stable and recovery time is more fast.