本文選題：異丙酚 + 腦電雙頻譜指數(shù)�。� 參考：《醫(yī)學(xué)理論與實(shí)踐》2016年17期

【摘要】：目的:探討閉環(huán)靶控異丙酚聯(lián)合瑞芬太尼麻醉在喉顯微手術(shù)中應(yīng)用的可行性。方法:擇期全麻下行喉顯微手術(shù)的患者60例。采用咪達(dá)唑侖、異丙酚、瑞芬太尼、順苯磺酸阿曲庫銨誘導(dǎo)。當(dāng)BIS值下降至60以下并穩(wěn)定30s以上時(shí),設(shè)置閉環(huán)系統(tǒng)中BIS的目標(biāo)值為45自動調(diào)節(jié)異丙酚輸注,以患者的平均動脈壓(MAP)和心率(HR)值為反饋指標(biāo)調(diào)節(jié)瑞芬太尼的靶濃度,保證MAP值在±20%基礎(chǔ)值,HR≥50次/min。記錄誘導(dǎo)前即刻(T1)、誘導(dǎo)后即刻(T2)、氣管插管后1min(T3)、置入支撐喉鏡前(T4)、置入支撐喉鏡后1min(T5)、置入支撐喉鏡后3min(T6)、置入支撐喉鏡后5min(T7)的BIS、HR、MAP的值,T3、T4、T5、T6、T7各個(gè)時(shí)點(diǎn)的異丙酚和瑞芬太尼的靶濃度;計(jì)算異丙酚的平均用藥量和平均靶濃度、不同麻醉深度(BIS40~60、BIS40及BIS60)的比例、停止藥物輸注到BIS達(dá)70、80及拔管的時(shí)間。結(jié)果:術(shù)中異丙酚的平均用藥量和平均靶濃度分別為(5.93±1.70)mg/(kg·h)和(2.07±0.29)μg/ml。維持期間,充分麻醉(BIS40~60)的比例為(87.66±3.47)%。停止藥物輸注到BIS達(dá)70、80的時(shí)間分別為(11.71±6.12)min和(14.56±6.55)min,拔管時(shí)間為(15.13±6.05)min。與T1時(shí)刻相比,T2和T4時(shí)刻的MAP值均降低(P0.05),T3和T5時(shí)刻的MAP值差異無統(tǒng)計(jì)學(xué)意義(P0.05)。與T1時(shí)刻相比,其他各時(shí)點(diǎn)的BIS值均降低(P0.05),與T4時(shí)刻相比,T5時(shí)刻的BIS值升高(P0.05)。與T2時(shí)刻相比,T3時(shí)刻HR值升高(P0.05)。結(jié)論:閉環(huán)靶控異丙酚聯(lián)合瑞芬太尼麻醉在喉顯微手術(shù)中應(yīng)用,術(shù)中可維持良好的麻醉深度,精確的調(diào)控方式使得術(shù)中的血流動力學(xué)更加平穩(wěn),蘇醒更加迅速。
[Abstract]:Objective: to investigate the feasibility of closed-loop target-controlled propofol combined with remifentanil anesthesia in laryngeal microsurgery. Methods: 60 patients underwent laryngeal microsurgery under elective general anesthesia. Midazolam, propofol, remifentanil and atracurium cisbenzenesulfonate were used. When the BIS value decreased below 60 and stabilized for 30 s, the target value of BIS in the closed-loop system was 45 to automatically regulate propofol infusion. The mean arterial pressure (map) and heart rate (HR) were used as feedback indicators to regulate the target concentration of remifentanil. The map value was kept at 鹵20% basic value and HR 鈮，

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