老年腹部手术患者BIS监测下异丙酚闭环与开环靶控输注模式的麻醉效果比较

Comparison of anesthetic effect between BIS-guided closed-loop and open-loop target controlled infusion of propofol in senile patients undergoing abdominal operation

目的探讨脑电双频指数(BIS)监测下异丙酚闭环与开环靶控输注在老年腹部手术患者中的麻醉效果。方法将76例老年腹部手术患者按照随机数字表法分为对照组38例[采用异丙酚开环靶控输注(OLTCI)]和研究组38例[采用异丙酚闭环靶控输注(CLTCI)]。比较两组患者的麻醉效果、麻醉药物使用情况、不同时间阶段血流动力学指标以及手术相关指标。结果在麻醉诱导阶段和麻醉维持阶段,研究组患者麻醉满意时间占比高于对照组,麻醉过深时间占比低于对照组,且麻醉维持阶段的麻醉过浅时间占比低于对照组(P<0.05或0.01)。研究组患者异丙酚诱导总量少于对照组,每小时泵调整次数多于对照组(P<0.01)。两组患者意识消失、插管即刻、插管后1 min时的心率(HR)均慢于麻醉诱导前,但研究组患者意识消失、插管即刻、插管后1 min时的HR均快于对照组(P<0.05或0.01)。研究组患者诱导阶段各时期的平均动脉压(MAP)水平无明显变化(P>0.05)。对照组患者意识消失、插管即刻、插管后1 min时的MAP水平均低于麻醉诱导前,且插管即刻、插管后1 min时的MAP水平低于研究组(P<0.05或0.01)。两组患者手术时间、麻醉时间、拔管时间、苏醒时间以及恶心、呕吐发生率等手术相关指标比较,差异无统计学意义(P>0.05)。结论对老年腹部手术患者行BIS监测下异丙酚CLTCI时,可按照BIS的数值及时调整异丙酚用量,避免了血流动力学指标的大幅度波动,可减少麻醉药物的用量,值得临床大力推广。

Objective To explore the effects of closed-loop and open-loop target controlled infusion(TCI)of propofol guided by bispectral index(BIS)in senile patients undergoing abdominal operation.Methods Seventy-six senile patients undergoing abdominal operation were divided into control(n=38,patients receiving BIS-guided open-loop TCL[OLTCI])and study group(n=38,ones doing BIS-guided closed-loop TCI[CLTCI])according to random number table.Such indexes were compared between two groups as anesthetic effects,use of anesthetic drugs,hemodynamic indexes at different time stages,and operation-related indexes.Results In anesthesia induction and anesthesia maintenance phases,the proportion of satisfaction time of anesthesia was higher,that of anesthesia too-deep time was lower,and so was that of anesthesia too-light time in study than control group in anesthesia maintenance phase(P<0.05 or 0.01).The total amount of propofol induction was less and pump adjustments per hour were more in study than cont rol group(P<0.01).The hear t rate(HR)of both groups were slower than those before anesthesia induction at the loss of consciousness,at the intubation and on 1 minute after intubation,but those were quicker in study than control group(P<0.05 or 0.01).There were no significant changes in mean arterial pressure(MAP)in each phase of induction in study group(P>0.05).The MAP levels were lower than those before before anesthesia induction at the loss of consciousness,at the intubation and on 1 minute after intubation in control group and those at the intubation and on 1 minute after intubation than study group(P<0.05 or 0.01).Intergroup differences in operation-related indexes as operation,anesthesia,extubation,and recovery time as well as and the incidence of nausea and vomiting weren't statistically significant(P>0.05).Conclusion When BIS-guided propofol CLTCI is performed in elderly patient undergoing abdominal operation,the dosage of propofol can be timely adjusted according to the value of BIS,which avoids the large fluctuation of hemodynamic indicators and reduce the dosage of anesthetic drugs,and is worthy of clinical promotion.