本文選題：BIS + 丙泊酚�。� 參考：《臨床麻醉學(xué)雜志》2015年10期

【摘要】：目的探討B(tài)IS指導(dǎo)下丙泊酚閉環(huán)靶控輸注在老年患者開腹手術(shù)中的應(yīng)用效果。方法擇期全麻下行開腹手術(shù)的老年患者60例,男38例,女22例,年齡65~80歲,ASAⅠ~Ⅲ級,隨機(jī)分為兩組:閉環(huán)組(A組)和開環(huán)組(B組),每組30例。兩組采用相同的誘導(dǎo)方式。BIS下降至60且連續(xù)15s小于或等于60時(shí)A組丙泊酚以BIS值45~55為目標(biāo)自動(dòng)閉環(huán)反饋輸注,B組手動(dòng)調(diào)節(jié)丙泊酚維持BIS在45~55之間。兩組均用肌松監(jiān)測反饋儀閉環(huán)輸注順阿曲庫銨,手動(dòng)調(diào)節(jié)瑞芬太尼。記錄入室后5min(T0)、插管即刻(Tl)、插管后3min(T2)、切皮后3min(T3)、腹腔探查時(shí)(T4)、縫皮結(jié)束時(shí)(T5)的BIS值、MAP、HR,記錄兩組麻醉時(shí)間、拔管時(shí)間及丙泊酚、瑞芬太尼、順阿曲庫銨、阿托品、麻黃堿、烏拉地爾和硝酸甘油等使用量,統(tǒng)計(jì)閉環(huán)系統(tǒng)性能指標(biāo):總體分?jǐn)?shù)(GS),充分麻醉(40BIS60)所占時(shí)間比例。用MMSE表對兩組患者術(shù)前1d、術(shù)后第3天和第5天的認(rèn)知功能進(jìn)行評分。結(jié)果兩組患者各時(shí)點(diǎn)HR差異無統(tǒng)計(jì)學(xué)意義。T4時(shí)A組MAP、BIS明顯高于B組(P0.05)。A組丙泊酚用量和靶控濃度明顯低于B組(P0.05),兩組患者瑞芬太尼、順阿曲庫銨使用量,麻黃堿、阿托品、烏拉地爾、硝酸甘油的使用例數(shù)差異無統(tǒng)計(jì)學(xué)意義。A組術(shù)后拔管時(shí)間[(27±8)min]明顯短于B組[(36±10)min](P0.05),A組GS[(28±10)分]明顯低于B組[(49±11)分](P0.05),充分麻醉(40BIS60)所占時(shí)間比例A組(82%±9%)明顯高于B組(67%±9%)(P0.05)。術(shù)后第5天MMSE,A組[(28.57±0.87)分]明顯高于B組[(26.83±0.91)分](P0.05),但術(shù)后認(rèn)知功能障礙的發(fā)生率差異無統(tǒng)計(jì)學(xué)意義。結(jié)論 BIS指導(dǎo)下丙泊酚閉環(huán)靶控輸注用于開腹手術(shù)的老年患者,麻醉效果良好,但在腹腔探查時(shí)患者血壓有波動(dòng);BIS指導(dǎo)下丙泊酚閉環(huán)靶控輸注可很好地維持BIS在設(shè)定的范圍內(nèi);可減少全身麻醉藥物的使用,縮短拔管時(shí)間,減輕對術(shù)后早期認(rèn)知功能的影響。
[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 鹵8)min] in group A was significantly shorter than that in group B [36 鹵10)min] P0.05A [28 鹵10], significantly lower than that in group B [49 鹵11)] P0.05. the proportion of time taken by adequate anesthesia of 40BIS60 in group A was 82% 鹵9%) significantly higher than that in group B (67% 鹵9m). On the 5th day after operation, the score of MMSE A group [28.57 鹵0.87] was significantly higher than that of group B [26.83 鹵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.
【作者單位】： 廣西醫(yī)科大學(xué)第一附屬醫(yī)院麻醉科;
【基金】：廣西壯族自治區(qū)教育廳自然科學(xué)科研項(xiàng)目(YB2014082)
【分類號】：R614

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