医药导报
醫藥導報
의약도보
HERALD OF MEDICINE
2015年
9期
1177-1180
,共4页
李晓晶%杨改生%杨继光%张小光
李曉晶%楊改生%楊繼光%張小光
리효정%양개생%양계광%장소광
丙泊酚%瑞芬太尼%靶控输注%脑电双频指数%手术,胆囊切除,腹腔镜
丙泊酚%瑞芬太尼%靶控輸註%腦電雙頻指數%手術,膽囊切除,腹腔鏡
병박분%서분태니%파공수주%뇌전쌍빈지수%수술,담낭절제,복강경
Propofol%Remifentanil%Target controlled infusion%Bispectral index%Cholecystectomy,laparoscopic
目的:探讨以脑电双频指数(BIS)为反馈控制变量的丙泊酚闭环靶控输注系统复合瑞芬太尼全凭静脉麻醉用于腹腔镜胆囊切除术的可行性。方法择期行腹腔镜胆囊切除手术患者40例,按照随机数字表法分为治疗组和对照组各20例,治疗组采用闭环靶控,设置反馈值为 BIS 45~55;对照组采用开环靶控,诱导时丙泊酚血浆靶控浓度设定为4μg?mL-1,麻醉维持时丙泊酚血浆靶控浓度设定为2~5μg?mL-1(根据 BIS 反馈值45~55人工调整)。诱导时两组瑞芬太尼以4 ng?mL-1靶控输注,麻醉维持时根据手术中情况调整瑞芬太尼用量。记录两组在诱导前(t0)、靶控输注 BIS值为50时(t1)、插管时(t2)、切皮时(t3)、手术开始5 min(t4)、切除胆囊时(t5)、缝皮时(t6)的平均动脉压(MAP)、心率(HR)、BIS 变化、诱导时间及丙泊酚用量。结果对照组在 t1、t3、t4、t5等时间点 MAP 较治疗组均明显下降(均 P<0.05);t5时间点 HR 变化较大(P<0.05)。治疗组和对照组在 t2时间点丙泊酚用量分别为(110.10±8.34),(120.55±6.26) mg;在t5时间点丙泊酚用量分别为(603.20±116.55),(759.50±116.37) mg(均 P<0.05)。结论以 BIS 为反馈值,丙泊酚闭环靶控输注复合瑞芬太尼全凭静脉麻醉用于腹腔镜胆囊切除手术,手术中患者麻醉深度易于维持,血流动力学稳定,丙泊酚用量明显减少。
目的:探討以腦電雙頻指數(BIS)為反饋控製變量的丙泊酚閉環靶控輸註繫統複閤瑞芬太尼全憑靜脈痳醉用于腹腔鏡膽囊切除術的可行性。方法擇期行腹腔鏡膽囊切除手術患者40例,按照隨機數字錶法分為治療組和對照組各20例,治療組採用閉環靶控,設置反饋值為 BIS 45~55;對照組採用開環靶控,誘導時丙泊酚血漿靶控濃度設定為4μg?mL-1,痳醉維持時丙泊酚血漿靶控濃度設定為2~5μg?mL-1(根據 BIS 反饋值45~55人工調整)。誘導時兩組瑞芬太尼以4 ng?mL-1靶控輸註,痳醉維持時根據手術中情況調整瑞芬太尼用量。記錄兩組在誘導前(t0)、靶控輸註 BIS值為50時(t1)、插管時(t2)、切皮時(t3)、手術開始5 min(t4)、切除膽囊時(t5)、縫皮時(t6)的平均動脈壓(MAP)、心率(HR)、BIS 變化、誘導時間及丙泊酚用量。結果對照組在 t1、t3、t4、t5等時間點 MAP 較治療組均明顯下降(均 P<0.05);t5時間點 HR 變化較大(P<0.05)。治療組和對照組在 t2時間點丙泊酚用量分彆為(110.10±8.34),(120.55±6.26) mg;在t5時間點丙泊酚用量分彆為(603.20±116.55),(759.50±116.37) mg(均 P<0.05)。結論以 BIS 為反饋值,丙泊酚閉環靶控輸註複閤瑞芬太尼全憑靜脈痳醉用于腹腔鏡膽囊切除手術,手術中患者痳醉深度易于維持,血流動力學穩定,丙泊酚用量明顯減少。
목적:탐토이뇌전쌍빈지수(BIS)위반궤공제변량적병박분폐배파공수주계통복합서분태니전빙정맥마취용우복강경담낭절제술적가행성。방법택기행복강경담낭절제수술환자40례,안조수궤수자표법분위치료조화대조조각20례,치료조채용폐배파공,설치반궤치위 BIS 45~55;대조조채용개배파공,유도시병박분혈장파공농도설정위4μg?mL-1,마취유지시병박분혈장파공농도설정위2~5μg?mL-1(근거 BIS 반궤치45~55인공조정)。유도시량조서분태니이4 ng?mL-1파공수주,마취유지시근거수술중정황조정서분태니용량。기록량조재유도전(t0)、파공수주 BIS치위50시(t1)、삽관시(t2)、절피시(t3)、수술개시5 min(t4)、절제담낭시(t5)、봉피시(t6)적평균동맥압(MAP)、심솔(HR)、BIS 변화、유도시간급병박분용량。결과대조조재 t1、t3、t4、t5등시간점 MAP 교치료조균명현하강(균 P<0.05);t5시간점 HR 변화교대(P<0.05)。치료조화대조조재 t2시간점병박분용량분별위(110.10±8.34),(120.55±6.26) mg;재t5시간점병박분용량분별위(603.20±116.55),(759.50±116.37) mg(균 P<0.05)。결론이 BIS 위반궤치,병박분폐배파공수주복합서분태니전빙정맥마취용우복강경담낭절제수술,수술중환자마취심도역우유지,혈류동역학은정,병박분용량명현감소。
Objective To evaluate the feasibility of propofol infusion by a closed-loop system for the titration of anaesthetic in laparoscopic cholecystectomy guided by Bispectral Index ( BIS). Methods Forty patients subjected to laparoscopic cholecystectomy randomly allocated into two groups: the control group with opened-loop titratioin of propofol TCI induced at a target of 4 μg?mL-1 and aintained from 2 to 5 μg?mL-1 and the treatment group with closed-loop titration was performed using a proportional differential algorithm.For both groups,the BIS was set at 45-55.Remifentanil TCI was infused at a target of 4 ng?mL-1 and was maintained according to the situation.The change in medial arterial pressure(MAP),heart rate (HR) and BIS were recorded before anesthesia(t0 ),target BIS of 50(t1 ),at tracheal intubation(t2 ),during incision of skin (t3 ),5 min after the operation(t4 ),at t5 of gallbladder removing and at t6 of skin suturing.The dose of propofol was calculated. Results Haemodynamic data were similar between groups during the induction.But MAP was decreased significantly at t1 ,t3 ,t4 , t5 in the control compared with the treatment group (P<0.05).HR changes a lot at t5 in the control compared with the treatment (P<0.05).Total dose of propofol in the treatment group was statistically lower than that in the controls [(110.10± 8.34) vs (120.55±6.26) mg; (603.20±116.55) vs (759.50±116.37) mg,P<0.05)]. Conclusion Automated titration guided by BIS for propofol infusion is feasible without increase in haemodynamic adverse effects and is of less propofol consumption in the laparoscopic cholecystectomy.