中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2013年
6期
574-577
,共4页
庞婷%李飞%靳三庆%李波%陈丽红%李欣洋%李冬雪%文依%蒋海
龐婷%李飛%靳三慶%李波%陳麗紅%李訢洋%李鼕雪%文依%蔣海
방정%리비%근삼경%리파%진려홍%리흔양%리동설%문의%장해
腹腔镜结直肠手术%丙泊酚%瑞芬太尼%靶控输注%脑电双频指数%收缩压
腹腔鏡結直腸手術%丙泊酚%瑞芬太尼%靶控輸註%腦電雙頻指數%收縮壓
복강경결직장수술%병박분%서분태니%파공수주%뇌전쌍빈지수%수축압
Laparoscopic colorectal surgery%Propofol%Remifentanil%Target-controlled infusions%Bispectral index%Systolic blood pressure
目的 探讨以脑电双频指数(BIS)和收缩压为滴定目标、以丙泊酚复合瑞芬太尼滴定靶控输注静脉麻醉对腹腔镜结直肠手术中麻醉用药量和麻醉深度的影响.方法 选择60例择期腹腔镜结直肠手术患者为研究对象,采用丙泊酚复合瑞芬太尼滴定靶控输注静脉麻醉,以BIS维持40～60、收缩压波动不超过基础值的20％为目标,滴定调节两种药物的血浆靶浓度,当BIS与收缩压的变化趋势出现矛盾时首先调节SBP.记录不同时间点的BIS、血压及麻醉药血浆靶控浓度等.结果 麻醉诱导后血压基本平稳,BIS维持在60以内,其中在人工气腹建立后和Trendelenburg体位期间,BIS低至35～40之间;整个麻醉过程中患者均无术中知晓.麻醉期间存在手术刺激时,丙泊酚和瑞芬太尼血浆靶浓度的95％CI分别为2.55～2.65 mg/L和4.09～4.26 μg/L,其中丙泊酚的血浆靶浓度所推荐剂量.结论 在腹腔镜结直肠手术中,以BIS结合收缩压为目标进行丙泊酚复合瑞芬太尼滴定靶控输注静脉麻醉,可维持有的麻醉深度,并减少麻醉药的用量.
目的 探討以腦電雙頻指數(BIS)和收縮壓為滴定目標、以丙泊酚複閤瑞芬太尼滴定靶控輸註靜脈痳醉對腹腔鏡結直腸手術中痳醉用藥量和痳醉深度的影響.方法 選擇60例擇期腹腔鏡結直腸手術患者為研究對象,採用丙泊酚複閤瑞芬太尼滴定靶控輸註靜脈痳醉,以BIS維持40～60、收縮壓波動不超過基礎值的20％為目標,滴定調節兩種藥物的血漿靶濃度,噹BIS與收縮壓的變化趨勢齣現矛盾時首先調節SBP.記錄不同時間點的BIS、血壓及痳醉藥血漿靶控濃度等.結果 痳醉誘導後血壓基本平穩,BIS維持在60以內,其中在人工氣腹建立後和Trendelenburg體位期間,BIS低至35～40之間;整箇痳醉過程中患者均無術中知曉.痳醉期間存在手術刺激時,丙泊酚和瑞芬太尼血漿靶濃度的95％CI分彆為2.55～2.65 mg/L和4.09～4.26 μg/L,其中丙泊酚的血漿靶濃度所推薦劑量.結論 在腹腔鏡結直腸手術中,以BIS結閤收縮壓為目標進行丙泊酚複閤瑞芬太尼滴定靶控輸註靜脈痳醉,可維持有的痳醉深度,併減少痳醉藥的用量.
목적 탐토이뇌전쌍빈지수(BIS)화수축압위적정목표、이병박분복합서분태니적정파공수주정맥마취대복강경결직장수술중마취용약량화마취심도적영향.방법 선택60례택기복강경결직장수술환자위연구대상,채용병박분복합서분태니적정파공수주정맥마취,이BIS유지40～60、수축압파동불초과기출치적20％위목표,적정조절량충약물적혈장파농도,당BIS여수축압적변화추세출현모순시수선조절SBP.기록불동시간점적BIS、혈압급마취약혈장파공농도등.결과 마취유도후혈압기본평은,BIS유지재60이내,기중재인공기복건립후화Trendelenburg체위기간,BIS저지35～40지간;정개마취과정중환자균무술중지효.마취기간존재수술자격시,병박분화서분태니혈장파농도적95％CI분별위2.55～2.65 mg/L화4.09～4.26 μg/L,기중병박분적혈장파농도소추천제량.결론 재복강경결직장수술중,이BIS결합수축압위목표진행병박분복합서분태니적정파공수주정맥마취,가유지유적마취심도,병감소마취약적용량.
Objective To evaluate the effect of titrated target-controlled infusion with propofol and remifentanil on anesthetics consumption and anesthesia depth in patients undergoing elective laparoscopic colorectal surgery.Methods Sixty ASA Ⅰ-Ⅲ patients for elective laparoscopic colorectal surgery were enrolled.Titrated target-controlled infusion (TCI) with propofol and remifentanil was performed.Plasma concentration of the drugs was administered by titrated method to maintain bispectral index(BIS) in the range of 40-60 with systolic blood pressure(SBP) fluctuation within 20％ of the basic value.BIS,SBP,plasma concentration of propofol and remifentanil were recorded at different time points.Awareness during operation was inquired postoperatively.Results During the entire anesthesia period,the blood pressure was stable and BIS was maintained less than 60.There was no awareness during operation.The plasma concentrations (95％ confidence interval) for TCI of propofol and remifentanyl were 2.55-2.65 mg/L and 4.09-4.26 μg/L respectively when existing surgical stimulation during anesthesia,and the plasms target concentration of propofol was lower than the recommended dosages.Conclusion Titrated target-controlled infusions with propofol and remifentanil for elective laparoscopic colorectal surgery can maintain proper anesthesia depth and reduce the drug consumption.
