异丙酚开环与闭环靶控输注在宫腔镜手术应用的比较

The application of opened-and closed-loop target controlled infusion of propofol in hysteroscopy surgery

目的:评价脑电双频谱指数(Bispectral index,BIS)作为异丙酚靶控输注的反馈控制变量用于宫腔镜手术病人的效果,并与异丙酚靶控开环系统进行比较。方法:60例择期在全凭静脉麻醉下行宫腔镜手术的病人,随机分为两组:反馈靶控输注组(FTCI)和靶控输注组(TCI)。异丙酚的血浆靶控浓度均设定为4μg/ml,靶控输注组整个手术期维持不变,反馈靶控输注组BIS作为控制变量设定在70。记录并比较两组BIS值、平均动脉压(MAP)和心率(HR)的最高值和最低值、异丙酚的单位标准化剂量、定向力恢复时间、术中的遗忘程度和满意度。结果:FTCI及TCI组BIS值最高值分别为68.1±2.1、76.0±8.6,组间对比有显著性差异(t=-5.058,P=0.000),最低值分别为61.0±3.2、50.9±11.8,组间对比有统计学意义(t=-3.513,P=0.000);平均动脉压的最高值分别为90.9±14.2、100.4±11.6,组间对比有显著性差异(t=-2.838,P=0.006),最低值分别为74.2±12.5、63.8±13.8,组间对比有统计学意义(t=-3.059,P=0.003);定向力恢复时间分别为440.8±141.0、576.4±120.5,两组也有统计学差异(t=-4.004,P=0.000);FTCI组异丙酚总剂量明显低于TCI输注组(分别为310.48±82.75与420.65±76.79,t=-5.345,P=0.000),单位标准化剂量亦较低(分别为5.08±1.26和6.02±0.86,t=-3.375,P=0.001);FTCI及TCI组病人术中的遗忘程度比较无显著性差异(分别为96.7%和93.3%,χ2=0.000,P=1.000),满意度组间对比也无统计学意义(分别为96.7%与86.7%,χ2=0.873,P=0.353)。结论:BIS作为异丙酚镇静的反馈控制变量安全可行,此输注系统为宫腔手术病人提供适宜的麻醉深度,且异丙酚用量少,定向力恢复快,术中血流动力学稳定。

Objective:To evaluation the efffects of bispectral index as the variable of feedbak control of propofol with closed-loop targart control infusion and compare with the opened-loop targart control infusion in hysteroscopy surgery.Methods:sixty ASAI-II women patients undergoing hysteroscopy surgery under epidural general anesthesion were randomly divided into two groups:feedback TCI group and TCI group 30 case each.In feedback TCI group,target concentration of propofol was set up at 4μg/ml,BIS value of 70 was set as the control variable.In TCI groups,the target concentration of propofol was set up at 2μg/ml throughout the anesthesia.The highest and lowest BIS and MAP and HR during operation,the standardized unit dose of propofol,doses of adjunctive drugs,time for orientation,amnesia and satisfactory degree were recorded and analyzed.Results FTCI group and TCI group values highest of BIS respectivly were 68.1±2.1 and 76.0±8.6 and significantly different between the two groups(t =-5.058,P=0.000),lowest values of BIS respectivly were 61.0±3.2 and 50.9±11.8 and significantly different between the two groups(t =-3.513,P=0.000);FTCI group and TCI group values highest of MAP during operation respectivly were 90.9±14.2 and 100.4±11.6 and significantly different between the two groups(t =-2.838,P=0.006),lowest values of MAP respectivly were 74.2±12.5 and 63.8±13.8 and significantly different between the two groups(t =-3.059,P=0.003);Time for orientation respectivly were 440.8±141.0s and 576.4±120.5s,and significantly different between the two groups(t =-4.004,P=0.000);Total dose of propofol was statistically lower in feedback TCI group than that in TCI group(respectivly were 310.48±82.75 and 420.65±76.79,t =-5.345,P=0.000),same was the standardized unit dose of propofol(respectivly were 5.08±1.26 and 6.02±0.86,t =-3.375,P=0.001).No significant differences were seen between the two groups in mnesia degree(respectivly were 96.7% and 93.3%,χ2 = 0.000,P=1.000) and satisfactory degree(respectivly were 96.7% and 86.7%,χ2 = 0.873,P=0.353) in feedback TCI group than that in TCI group.Conclusions As a feedback control BIS is useful in propofol anesthesia with TCI.The feedback TCI sedation was recammended in laparoscopic hysterectomy with the advantages of less propofol,appropriate sedation,rapid orientation and more stable blood pressure