CAJ | 학술논문

目的观察靶控输注方式对老年患者麻醉剂用量、血流动力学和苏醒等方面的影响.方法 2009年4月至2010年2月于北京大学第三医院行腹腔镜结直肠癌手术的65岁以上患者60例,经过医院伦理委员会的批准,根据随机数字表将患者随机分为手控输注(MCI组,n=30例)和靶控输注(TCI组,n=30例).麻醉诱导,MCI组丙泊酚输注速度为200 ml/h,TCI组初始丙泊酚血浆浓度2.0μg/ml,逐渐增加靶浓度,至患者意识消失.两组瑞芬太尼输注方案相同.气管插管后根据脑电双频指数(BIS)调整丙泊酚输注速度或靶浓度,根据血流动力学参数变化调整瑞芬太尼输注速度.记录患者意识消失时间、插管时间、诱导和维持阶段丙泊酚和瑞芬太尼用量、血压、心率、调整泵速或靶浓度的次数及苏醒时间.结果两组患者意识消失时间、插管时间、意识消失时丙泊酚用量、维持期丙泊酚用量、插管前及维持期间瑞芬太尼用量的差异无统计学意义,在维持过程中TCI调整靶浓度的次数明显低于MCI组调整输注速度的次数[(5.8±2.1)vs(7.8±3.7)次,P＜0.01].两组患者BIS值、血压、心率的变化、血管活性药的应用、苏醒时间的差异无统计学意义.结论虽然靶控输注系统操作简单,维持过程中调整次数少,但在老年人采用靶控输注在诱导和维持期丙泊酚用量、维持血流动力学和麻醉深度的稳定性、以及术后苏醒等方面,无明显优势.
목적 관찰파공수주방식대노년환자마취제용량、혈류동역학화소성등방면적영향.방법 2009년4월지2010년2월우북경대학제삼의원행복강경결직장암수술적65세이상환자60례,경과의원윤리위원회적비준,근거수궤수자표장환자수궤분위수공수주(MCI조,n=30례)화파공수주(TCI조,n=30례).마취유도,MCI조병박분수주속도위200 ml/h,TCI조초시병박분혈장농도2.0μg/ml,축점증가파농도,지환자의식소실.량조서분태니수주방안상동.기관삽관후근거뇌전쌍빈지수(BIS)조정병박분수주속도혹파농도,근거혈류동역학삼수변화조정서분태니수주속도.기록환자의식소실시간、삽관시간、유도화유지계단병박분화서분태니용량、혈압、심솔、조정빙속혹파농도적차수급소성시간.결과 량조환자의식소실시간、삽관시간、의식소실시병박분용량、유지기병박분용량、삽관전급유지기간서분태니용량적차이무통계학의의,재유지과정중TCI조정파농도적차수명현저우MCI조조정수주속도적차수[(5.8±2.1)vs(7.8±3.7)차,P＜0.01].량조환자BIS치、혈압、심솔적변화、혈관활성약적응용、소성시간적차이무통계학의의.결론 수연파공수주계통조작간단,유지과정중조정차수소,단재노년인채용파공수주재유도화유지기병박분용량、유지혈류동역학화마취심도적은정성、이급술후소성등방면,무명현우세.
Objective To evaluate the impact of anesthesia via target-controlled infusion (TCI) on drug consumption, intraoperative hemodynamic stability and recovery compared with manual-controlled infusion (MCI) in elderly patients. Methods Under the approval of the hospital ethics committee, 60elderly patients undergoing laparoscopic surgery were randomly allocated by random numbers to either the MCI group (n =30) or the TCI group (n =30). The patients in MCI group received an infusion of propofol at 200 ml/h while those in TCI group propofol at an initial plasma concentration of 2.0μg/ml and titrated upwards by 0.5μg/ml steps until loss of consciousness. Both groups received an infusion of remifentanil.After intubation, the infusion rate or the target concentration of propofol was titrated to maintain BIS (bispectral index) values between 40 and 60. The infusion of remifentanil was adapted to intraoperative hemodynamics. The doses of propofol and remifentanil were recorded, the hemodynamic parameters and the use of vasoactive drugs collected and the recovery times assessed. Results The time of loss of consciousness and the time to intubation, the doses of propofol and remifentanil during induction and maintenance were not significantly different between two groups. The times of pump adjustment were less in TCI group versus MCI group [(5.8±2.1)vs(7.8±3.7) times, P＜0.01]. Blood pressure and heart rates were not statistically different at any time point between two groups. There were no significant differences in BIS or the use of vasoactive drugs between two groups. The recovery times were similar for two groups. Conclusion Although target infusion system is easy to use and requires less time of adjustment, it fails to show added benefit on propofol consumption, hemodynamic stability, anesthesia depth and recovery in elderly patients.