BIS指导下丙泊酚闭环靶控输注在老年患者开腹手术中的应用

发布时间：2018-04-24 05:10

本文选题：BIS + 丙泊酚　；参考：《临床麻醉学杂志》2015年10期

【摘要】：目的探讨BIS指导下丙泊酚闭环靶控输注在老年患者开腹手术中的应用效果。方法择期全麻下行开腹手术的老年患者60例,男38例,女22例,年龄65~80岁,ASAⅠ~Ⅲ级,随机分为两组:闭环组(A组)和开环组(B组),每组30例。两组采用相同的诱导方式。BIS下降至60且连续15s小于或等于60时A组丙泊酚以BIS值45~55为目标自动闭环反馈输注,B组手动调节丙泊酚维持BIS在45~55之间。两组均用肌松监测反馈仪闭环输注顺阿曲库铵,手动调节瑞芬太尼。记录入室后5min(T0)、插管即刻(Tl)、插管后3min(T2)、切皮后3min(T3)、腹腔探查时(T4)、缝皮结束时(T5)的BIS值、MAP、HR,记录两组麻醉时间、拔管时间及丙泊酚、瑞芬太尼、顺阿曲库铵、阿托品、麻黄碱、乌拉地尔和硝酸甘油等使用量,统计闭环系统性能指标:总体分数(GS),充分麻醉(40BIS60)所占时间比例。用MMSE表对两组患者术前1d、术后第3天和第5天的认知功能进行评分。结果两组患者各时点HR差异无统计学意义。T4时A组MAP、BIS明显高于B组(P0.05)。A组丙泊酚用量和靶控浓度明显低于B组(P0.05),两组患者瑞芬太尼、顺阿曲库铵使用量,麻黄碱、阿托品、乌拉地尔、硝酸甘油的使用例数差异无统计学意义。A组术后拔管时间[(27±8)min]明显短于B组[(36±10)min](P0.05),A组GS[(28±10)分]明显低于B组[(49±11)分](P0.05),充分麻醉(40BIS60)所占时间比例A组(82%±9%)明显高于B组(67%±9%)(P0.05)。术后第5天MMSE,A组[(28.57±0.87)分]明显高于B组[(26.83±0.91)分](P0.05),但术后认知功能障碍的发生率差异无统计学意义。结论 BIS指导下丙泊酚闭环靶控输注用于开腹手术的老年患者,麻醉效果良好,但在腹腔探查时患者血压有波动;BIS指导下丙泊酚闭环靶控输注可很好地维持BIS在设定的范围内;可减少全身麻醉药物的使用,缩短拔管时间,减轻对术后早期认知功能的影响。
[Abstract]:Objective to investigate the effect of closed-loop target-controlled infusion of propofol under the guidance of BIS in the elderly patients undergoing open surgery. Methods A total of 60 elderly patients (38 males and 22 females) undergoing open surgery under elective general anesthesia were randomly divided into two groups: closed loop group (group A) and open loop group (group B, 30 cases in each group). The two groups adopted the same induction mode. BIS decreased to 60 and was less than or equal to 60 for 15 s continuously. Group A received propofol with BIS value of 45 ~ 55 as the target. Group B was given automatic closed-loop feedback to adjust propofol to maintain BIS between 45 and 55 by hand. Both groups were treated with muscle relaxation monitor and closed loop infusion of cisatracurium, and remifentanil was manually adjusted. The BIS values of T0, T0, T2, T2, T3, T4 and T5 were recorded. The anesthesia time, extubation time and propofol, remifentanil, cyatracurium, atropine, ephedrine, ephedrine were recorded, and the time of anesthesia, extubation and propofol, remifentanil, shun atracurium, atropine, ephedrine were recorded, and the time of anesthesia, extubation and propofol, remifentanil, cisatracurium, atropine, ephedrine were recorded. The usage of urapidil and nitroglycerin, and the ratio of time to time of the closed loop system performance index: total score of GSN, full anesthesia of 40BIS60). The cognitive function of the two groups was evaluated with MMSE table 1 day before operation, 3 days and 5 days after operation. Results there was no significant difference in HR between the two groups at different time points. The level of MAPBIS in group A was significantly higher than that in group B (P 0.05). The concentration of propofol and target control in group A was significantly lower than that in group B (P 0.05). The dosage of remifentanil, cisatracurium, ephedrine and atropine were significantly lower in group A than in group B. There was no significant difference in the use of urapidil and nitroglycerin. The extubation time [27 卤8)min] in group A was significantly shorter than that in group B [36 卤10)min] P0.05A [28 卤10], significantly lower than that in group B [49 卤11)] P0.05. the proportion of time taken by adequate anesthesia of 40BIS60 in group A was 82% 卤9%) significantly higher than that in group B (67% 卤9m). On the 5th day after operation, the score of MMSE A group [28.57 卤0.87] was significantly higher than that of group B [26.83 卤0.91] P 0.05, but there was no significant difference in the incidence of postoperative cognitive dysfunction. Conclusion the anesthesia effect of propofol closed-loop target-controlled infusion under BIS guidance for the elderly patients undergoing open operation is good, but under the guidance of blood pressure fluctuation in patients with intraperitoneal exploration, the closed-loop target-controlled infusion of propofol can maintain BIS within the set range. It can reduce the use of general anesthetic, shorten the time of extubation and reduce the effect of early postoperative cognitive function.
【作者单位】：广西医科大学第一附属医院麻醉科;
【基金】：广西壮族自治区教育厅自然科学科研项目(YB2014082)
【分类号】：R614

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