手控与靶控输注瑞芬太尼用于自主呼吸患者的比较研究

背景丙泊酚和瑞芬太尼联合输注用于保留自主呼吸患者的深度镇静时常常会发生一些副反应,尤其是呼吸抑制。这些副反应的产生可能与药物的组合以及给药技术有关。靶控输注（TCI）可能会优化给药方法。因此,在这项对择期结肠镜检术患者进行的前瞻性随机双盲研究中,我们试图回答以下两个问题：第一,使用丙泊酚的同时加用瑞芬太尼是否利大于弊。第二,与手控输注相比,靶控输注瑞芬太尼是否可以减少副反应的发生。方法接受择期结肠镜检术的患者被随机分组：接爱手控持续输注瑞芬太尼细（MCI）（0．125μg·kg^-1·min^-1的速度持续输注2分钟后改为0．05μg·kg^-1·min^-1的速度持续输注）,靶控输注瑞芬太尼组（TCI）（1ng／ml）,或安慰剂组（生理盐水靶控输注或以相应的速度手控持续输注）。所有患者都接受丙泊酚靶控输注,调整靶浓度至相应水平使得患者处于深度镇静、对语言指令无反应的同时保留自主呼吸且不需要辅助通气。结果安慰剂组发生沐动、咳嗽和呃逆、暂时干扰检查操作的人数显著多于研究绍、各组间血流动力学和苏醒指标没有显著临床差异．靶控输注瑞芬太尼减少了丙泊酚的用量。使用瑞芬太尼时,靶控输注组（TCI）与手控输注组（MCI）相比,呼吸减弱和呼吸暂停的发生率明显减低（TCI：n=7,MCI：n=16,P〈0．05）.结论瑞芬太尼和丙泊酚联合应用于保留自主呼吸的深度镇静时比单独丙泊酚能提供更好的结肠镜检术条件与手控输注瑞芩太尼相比,靶控输注瑞芬太昆可以减少丙泊酚的用量并减少呼吸暂停和呼吸抑制的发生率（TCI：n=7,MCI：n=16,P〈0．05）.     

丙泊酚靶控加单次硬膜外麻醉在儿外手术中的应用

目的观察儿外手术中应用丙泊酚靶控麻醉复合单次硬膜外麻醉的过程，并与氯胺酮全麻相比较，评价丙泊酚靶控加单次硬膜外麻醉应用于儿外手术的临床效果及安全性。方法选择拟施手术年龄2～12岁的患儿42例，随机分为两组：K组（n=21）为氯胺酮组，P组（n=21）为单次硬膜外加丙泊酚靶控输注组，观察两组基础麻醉后入室时R、切皮时T0、结束时T2各时点患儿收缩压（SBP）、舒张压（DBP）、心率（HR）、血氧饱和度（SpO2）及术中肢动挣扎、肌松满意度、苏醒时间、苏醒延迟等指标。结果K组SBP、DBP、HR在T1、T2与T0相比均显著升高（P〈0．05），P组SBP、DBP无明显改变，但在T1、T2均较K组低（P〈0．05），P组HR在T1、T2较T0降低（P〈0．05），较K组同时点显著降低（P〈0．01）。P组肢动挣扎例数明显少于K组（P〈0．01），肌松满意度好于K组（P〈0．05），苏醒时间明显缩短（P〈0．01），苏醒延迟等指标明显少于K组（P〈0．01）。结论单次硬膜外加丙泊酚靶控用于儿外手术麻醉对呼吸循环影响较小，具有麻醉效果好、术后苏醒快、安全可靠的特点。     

丙泊酚或异氟醚麻醉对肾素-血管紧张素系统的影响

目的比较丙泊酚靶控输注（TCI）或异氟醚吸入麻醉对肾素-血管紧张素系统（RAS）和血流动力学的影响。方法择期行胃切除手术的患者30例，ASAI或Ⅱ级，随机分成丙泊酚TCⅠ组（Ⅰ组）和异氟醚吸入麻醉组（Ⅱ组），每组15例。丙泊酚、芬太尼诱导后，Ⅰ组丙泊酚TCI维持麻醉，Ⅱ组异氟醚、氧化亚氮低流量吸入维持麻醉。麻醉中以听觉诱发电位（AEP）和脑电双频指数（BIS）作为麻醉深度指标，记录麻醉前（T1）、诱导插管后5min（T2）、切皮（T3）、探查（T4）、术毕拔管后5min（T5）时BP、HR、AEP、BIS、血浆肾素活性（PRA）和血管紧张素Ⅱ（AngⅡ）值。结果与T1时比较，T2时两组PRA、AngU和BP均显著下降（P〈0．01），T3、T4时Ⅰ组PRA显著下降，而Ⅱ组AngⅡ显著增高（P〈0．01）。T3、T4时Ⅱ组PRA均显著高于Ⅰ组（P〈0．01），T3、T4和T5时Ⅱ组AngⅡ显著高于Ⅰ组（P〈0．05）。T4时Ⅱ组BP和HR显著高于T1时（P〈0．05）。T5时Ⅰ组BIS显著低于Ⅱ组（P〈0．05）。结论丙泊酚TCI可抑制RAS，应激反应轻，优于异氟醚吸入麻醉。     

靶控输注与手控注射丙泊酚用于人工流产术麻醉的比较

丙泊酚具有起效快、作用时间短、苏醒迅速等特点，已被广用于门诊短小手术的麻醉。采用丙泊酚靶控输注(TCI)方法，与传统静脉输注丙泊酚比较，具有可控性高和简便精确的明显优势。本文将丙泊酚的TCI法与手控注射(MCI)法的应用结果进行比较，报道如下。     

丙泊酚靶控输注Marsh模式和Schnider模式在宫腔镜手术中的应用比较

目的比较丙泊酚靶控输注Marsh模式和Schnider模式在宫腔镜手术中的应用效果。方法选取2017年1月至2018年6月于中山大学孙逸仙纪念医院择期行宫腔镜手术患者60例,年龄20～60岁,BMI 18～30,ASA分级Ⅰ～Ⅱ级,分为两组,Marsh组(M组),n=30和Schnider组(S组),n=30。两组分别以Marsh模式和Schnider模式靶控输注丙泊酚进行麻醉,并用Narcotrend监测麻醉深度。记录手术时间、丙泊酚用量、术中体动次数、调整TCI参数次数、术中低血压次数、窦性心动过缓次数、辅助呼吸次数。采集基础状态(T_0)、意识消失(T_1)、扩张宫颈(T_2)、麻醉结束(T_3)时的NTI。并记录苏醒时间、恶心呕吐和寒战例数。结果M组和S组两组患者ASA分级、年龄、BMI、手术时间比较差异无统计学意义(P0.05);M组单位时间丙泊酚用量少于S组,差异有统计学意义(P0.01);M组患者术中体动次数多于S组,差异有统计学意义(P0.05),术中调整TCI参数次数也多于S组,差异有统计学意义(P0.01),但两组术中低血压、窦性心动过缓和辅助呼吸次数差异无统计学意义(P0.05);基础状态(T_0)时,M组和S组两组NTI比较差异无统计学意义(P0.05);在意识消失(T_1)和扩张宫颈(T_2)时,M组NTI高于S组,差异有统计学意义(P0.01);在麻醉结束(T_3)时,M组和S组两组NTI比较差异无统计学意义(P0.05);M组和S组两组患者苏醒时间、恶心呕吐和寒战例数比较差异无统计学意义(P0.05)。结论宫腔镜手术中,丙泊酚Schnider靶控输注模式优于Marsh模式。     

反馈靶控输注和自控输注丙泊酚用于硬膜外麻醉病人的镇静

目的 比较反馈靶控输注(TCI)和病人自控镇静(PCS)在硬膜外麻醉下择期手术病人中的应用。方法 选择50例ASAⅠ～Ⅱ级、年龄18～70岁的妇科择期手术病人,随机分成T组(TCI)和P组(PCS),每组25例。硬膜外穿刺成功后,使麻醉平面维持在T6以下,同时连接TCI系统和PCS系统并设置参数。切皮前5min开始系统给药,手术结束前5min停止给药,持续观察脑电双频指数(BIS)、频谱边界频率(SEF)、高频(HF)、低频(LF)的变化,并评定镇静深度(OAA／S评分法)。术毕记录丙泊酚的总用量及按压次数、苏醒时间和手术医师的满意度评分。结果 P组丙泊酚用量明显少于T组(P＜0．01),而各时间点MAP、BIS、SEF、HF、LF、LF／HF、HRV的变化无显著性差异(P＞0．05),两组病人及手术医师的满意度一致(P＞0．05)。结论 PCS和反馈TCI是两种安全有效的镇静方法。     

持续靶控输注丙泊酚与吸入异氟醚维持麻醉的比较

目的：比较持续靶控输液丙泊酚与吸入异氟醚维持麻醉下的应激反以及对血液动力学变化的影响。方法：择期行妇科手术病人20例，ASA I－Ⅱ级，随机分为靶控（T）组，吸入（I）组，每组各10例，丙泊酚靶控行麻醉诱导，气管插管后T组靶控维持，I组异氟醚吸入维持，术中控制麻醉深度于双频指数在（BIS）40－60之间，记录术前至术毕不同时点的皮质醇（Cor),血糖（Glu)，胰岛素（Ins)，血压，心率和BIS值，结果：与基础对比，诱导后两组皮质醇值都显著下降（P＜0．05），切皮后30分钟至关腹两组值均上升，且T组幅度略大，组间差异显著（P＜0．05），血糖值在切皮后均显著上升，I组术中高于T组，术毕低于T组（P＜0．05），T组胰岛素值轻度上升，与基础值比较无差异；I组在插管后10分钟时一过性抑制，与自身和T组比较差异显著（P＜0．05），诱导后两组收缩压，舒张压，心率均较基础值显著下降（P＜0．05），I组在插管后5－10分钟内收缩压，舒张压，心率抑制明显（P＜0．05），大多数病人需注射阿托品，两组BIS值在插管后5分钟和关腹时I组显著低于T组（P＜0．05），结论：靶 控输注能较好地抑制应激反应，维持心血管功能的稳定。     

持续静脉输注ATP对腹部手术患者靶控输注异丙酚效应室浓度的影响

目的探讨腹部手术患者麻醉中持续静脉输注ATP对靶控输注异丙酚效应室浓度的影响。方法择期下腹部手术患者60例,ASAⅠ级或Ⅱ级,年龄44～64岁,体重49～87kg,随机分为3组（n=20）：异丙酚组（P组）单纯靶控输注异丙酚维持麻醉;ATP1组和ARP2,组在靶控输注异丙酚的同时,分别以微量泵持续静脉输注ATP 0．4 mg·kg^-1·h^-1和0．6mg·kg^-1·h^-1。术中根据BIS、MAP、HR调整异丙酚血浆靶浓度。当BIS＞55或BIS＜40时则以0．2μg/ml幅度增加或降低异丙酚靶浓度。术中静脉输注芬太尼,并根据需要使用血管活性药物。于麻醉诱导前即刻（T0）、气管插管前即刻（T1）、气管插管后即刻（T2）、切皮前即刻（T3）、切皮后10 min（T4）和60 min（L5）、术毕（T5）、呼之睁眼（L7）以及气管拔管后即刻（L8）记录HR、MAP、SpO2、BIS。记录麻醉全程异丙酚效应室浓度及停止靶控输注后TCI泵所显示的效应室浓度。结果3组一般资料、麻醉时间、芬太尼用量及苏醒时间比较差异无统计学意义（P＞0．05）。3组MAP、HR及SpO2维持在正常范围。术中异丙酚效应室浓度：与P组比较, ATP1组在T4至T8时降低,ATP2组在T1至T8时降低（p＜0．05或0．01）;与ATP1组比较,ATP2组T5至T7时降低（P＜0．05）。结论腹部手术患者麻醉中,BIS维持40～55时,ATP 0．4～0．6 mg·kg^-1·h^-1持续静脉输注可降低靶控输注异丙酚效应室浓度,且随ATP用药量的增加,异丙酚用药量相应减少,且不影响苏醒时间。     

靶控输注雷米芬太尼和丙泊酚静脉麻醉临床性能评价

目的观察不同年龄对雷米芬太尼靶控输注（TCI）药代动力学模型参数的影响、分析靶浓度与实测浓度的差值并评价TCI系统的性能。方法60例上腹部手术患者随机分为A组（28岁-44岁,n=20）,B组（45岁-64岁,n=30）,C组（65岁-80岁,n=20）。全麻诱导设定丙泊酚血浆靶控浓度3 mg／L,雷米芬太尼7μg／L。意识消失后给予维库溴铵0．1 mg／kg气管插管后行机械通气。气管插管后丙泊酚的靶控浓度降至2．5 mg/L,雷米芬太尼靶控浓度维持不变。术中调节丙泊酚的量使BIS指数维持在45-55。TCI开始后5 min、10 min、20 min、40 min、60 min、80 min、100 min、120 min抽取动脉血检测雷米芬太尼血药浓度。采用执行误差（PE）的中位数（MDPE）、执行误差的绝对中位数（MDPAE）及摆动度（wobble）评价TCI系统的性能。结果三组患者各时点血浆雷米芬太尼浓度均明显低于靶浓度。输注后5 min、10 min,C组的血浆雷米芬太尼浓度显著高于A、B组,有统计学差异（P〈0．05）,而其他各时段两组间无统计学差异（P〉0．05）。三组患者TCI系统偏离度（MDPE）在正常范围, MDAPE大于该范围,摆动度也较大。结论TCI时靶控浓度与实测血药浓度差异较大,老年人的药代动力学特征明显不同于青壮年,在国人使用雷米芬太尼TCI静脉麻醉时,应根据不同年龄设定靶控浓度。     

不同模式输注雷米芬太尼用于甲状腺手术的比较

目的 比较不同模式输注雷米芬太尼用于颈丛神经阻滞甲状腺手术的临床效果,探讨其最佳模式和安全性.方法 96例ASA Ⅰ级择期甲状腺手术患者,年龄23～46岁,体重46～73kg,随机分成人工控制输注组(Ⅰ组)、靶控输注(TCI)组(Ⅱ组),每组48例.两组均在颈丛神经阻滞后采用人工控制或TCI输注雷米芬太尼.Ⅰ组雷米芬太尼以0.12 μg·kg-1·min-1速度输注,3 min后改为0.05 μg·kg-1·min-1,术中以0.01 μg·kg-1·min-1速度递增或递减,最大剂量不超过0.08 μg·kg-1·min-1;Ⅱ组以血浆靶浓度为2 ng/ml输注,术中以0.1 ng/ml速度递增或递减,最大剂量不超过3 ng/ml.皮肤缝合时停止药物输注.记录患者在麻醉前(To)、切皮时(T1)、分离峡部或腺体上极时(T2)、切除腺体时(T3)、缝合皮肤时(T4)的改良镇静/警醒评分(OAA/S),两组雷米芬太尼用量.观察呼吸抑制、心动过缓、低血压等不良反应的发生情况.结果 Ⅰ组雷米芬太尼用量明显少于Ⅱ组(P＜0.01).两组间各时点OAA/S差异无统计学意义,组内麻醉后各时点OAA/S明显高于T0(P＜0.05).Ⅰ组的呼吸抑制发生例数明显少于Ⅱ组(P＜0.05).结论 雷米芬太尼人工控制输注比TCI更适合用于颈丛神经阻滞下甲状腺手术.     

脑电双频指数-靶控输注注射泵闭环丙泊酚靶控输注应用于妇科腹腔镜手术的安全效益研究

目的 观察BIS-靶控输注(target controlled infusion,TCI)注射泵闭环丙泊酚TCI对妇科腔镜手术患者丙泊酚的节约效应及血流动力学的影响. 方法 纳入ASA分级Ⅰ、Ⅱ级择期行妇科腔镜手术的患者40例,采用计算机随机数字表分组分为闭环组和开环组,每组20例.闭环组采用BIS监测闭环丙泊酚TCI维持全身麻醉,开环组采用BIS监测下人工调整丙泊酚TCI血浆效应浓度2～5 mg/L维持全身麻醉,BIS目标值50±5;瑞芬太尼血浆效应浓度4μg/L TCI.记录两组在入室后5 min(T0)、诱导后气管插管前(T1)、插管后1 min(T2)、插管后5 min(T3)、手术切皮时(T4)、切皮后30 min(T5)、缝皮(T6)、手术结束(T7)、意识恢复(T8)、拔管即刻(T9)及拔管后5 min(T10)等时点MAP、HR、BIS值的变化,同时记录两组患者诱导及维持丙泊酚用药量、苏醒时间及进入PACU时的疼痛数字评分(numerical rating scale,NRS)及Ramsay镇静评分. 结果 术中维持丙泊酚剂量闭环组[(6.2±1.4) mg· kg-1·h-1]较开环组[(6.9±1.0)mg·kg-1·h-1]降低了10％,两组各时点MAP、HR、BIS差异无统计学意义(P＞0.05),闭环组切皮时MAP、HR、BIS波动明显小于开环组(P＜0.05).两组患者苏醒时间、NRS及Ramsay镇静评分差异无统计学意义(P＞0.05). 结论 BIS-TCI注射泵闭环丙泊酚TCI与常规BIS监测下开环丙泊酚TCI可同样安全地应用于临床,可对患者个体化合理给予全身麻醉药物,并可部分降低术中丙泊酚使用剂量,降低麻醉后手术前的循环波动.同时,避免麻醉医师手动调控TCI靶控血浆浓度,极大地降低了麻醉医师的工作量,并使围麻醉期更加平稳安全.     

Target-controlled infusion anesthesia with propofol and remifentanil compared with manually controlled infusion anesthesia in mastoidectomy surgeries

Target-controlled infusion (TCI) system is increasingly used in anesthesia to control the concentration of selected drugs in the plasma or at the site of drug effect (effect-site). The performance of propofol TCI delivery when combined with remifentanil in patients undergoing elective surgeries has been investigated. Our aim in this study was to assess the anesthesia profile of the propofol and remifentanil target controlled infusion (TCI) anesthesia as compared to the manually controlled infusion (MCI), in mastoidectomy surgery, where a bloodless field is of utmost importance to the surgeon. Sixty patients, aged 18-60 years ASA I-II enrolled in the study, were divided into two equal groups. Group MCI received propofol and remifentanil by conventional-dose-weight infusion method, and Group TCI received propofol 4 microg/ml and remifentanil 4 ng/ml as effect-site target concentration. The hemodynamic variability, recovery profile, postoperative nausea and vomiting (PONV), surgeons satisfaction were assessed. Results were analyzed by SPSS version 11.5. The two groups were comparable with respect to age, ASA class, sex, weight, basal vital signs, operation time. The blood pressure and pulse were above desired levels in some data points in the MCI Group (P < or = 0.05). The PACU stay time to reach Aldret score of 10 was longer in the MCI Group (42.54 +/- 8 vs 59.01 +/- 6 min) (P < or = 0.05). The PONV was more common in the MCI Group (P < or = 0.05). Surgeon's satisfaction of the surgical field showed no significant differences except when described as "good", more common in the TCI Group. TCI is capable to induce and maintain anesthesia as well as MCI. In some stages of anesthesia, the TCI control of vital signs are better than the MCI. In some stages of anesthesia, the TCI control of vital signs are beter than the MCI. Recovery profile and complication rate and surgeon's satisfactions are more acceptable in the TCI than in the MCI Group.     

Propofol formulated with long-/medium-chain triglycerides reduces the pain of injection by target controlled infusion

BACKGROUND: Propofol is a widely used intravenous anesthetic although its injection pain is a common and unpleasant problem. Long-/medium-chain triglyceride (LCT/MCT) propofol has been introduced, as its low free propofol content is expected to reduce injection pain compared with LCT propofol. Target controlled infusion (TCI) differs from conventional induction in the initial infusion pattern. During induction using TCI, we investigated injection pain caused by two propofol solutions with different triglyceride compositions. METHODS: Fifty patients, ASA I-II, with adequate communicative ability, were randomly assigned to two groups. TCI was conducted with Diprifusor for LCT and with BeComSim (custom-made software) for LCT/MCT. The target blood concentration was set at 4 microg/ml for both groups. At 30, 60, and 120 s after the infusion, patients were asked questions regarding the severity of pain on a 0-10 pain score. The total dose of propofol and the time required to induce anesthesia were also investigated. RESULTS: The LCT/MCT propofol group had a larger number of pain-free patients and showed lower severity of pain than the LCT group [the number of pain-free patients being 11 and 3, respectively (P < 0.05), and median maximum pain being 0 and 4.5, respectively (P < 0.01)]. The dose and time required for induction were not significantly different between the groups (dose of 84 +/- 27 and 80 +/- 24 mg, respectively, and time of 119 +/- 60 and 107 +/- 55 s, respectively). CONCLUSION: Our study showed that the frequency and severity of pain during TCI induction with propofol could be significantly reduced using LCT/MCT propofol rather than LCT propofol.     

Target-controlled infusion or manually controlled infusion of propofol in high-risk patients with severely reduced left ventricular function

OBJECTIVE: To compare hemodynamics, time to extubation, and costs of target-controlled infusion (TCI) with manually controlled infusion (MCI) of propofol in high-risk cardiac surgery patients. DESIGN: Prospective, randomized. SETTING: Major community university-affiliated hospital. PARTICIPANTS: Twenty patients undergoing first-time implantation of a cardioverter-defibrillator with severely reduced left ventricular function (left ventricular ejection fraction <30%). INTERVENTIONS: Anesthesia was performed using remifentanil, 0.2 to 0.3 microg/kg/min, and propofol. Propofol was used as TCI (plasma target concentration, 2 to 3 microg x mL; n = 10) or MCI (2.5 to 3.5 mg/kg/hr; n = 10). MEASUREMENTS AND MAIN RESULTS: Hemodynamics were measured at 6 data points: T1, before anesthesia; T2, after intubation; T3, after skin incision; T4, after first defibrillation; T5, after third defibrillation; and T6, after extubation. There were no significant hemodynamic differences between the 2 groups. Dobutamine was required to maintain cardiac index >2 L/min/m(2) in significantly more patients of the TCI group than of the MCI group. Mean dose of propofol was higher in the TCI patients (6.0 +/- 1.0 mg/kg/hr) than in the MCI patients (3.0 +/- 0.4 mg/kg/hr) (p < 0.05), whereas doses of remifentanil did not differ. Time to extubation was significantly shorter in the MCI (11.9 +/- 2.4 min) versus the TCI group (15.6 +/- 6.8 min). Costs were significantly lower in MCI patients (34.73 dollars) than in TCI patients (44.76 dollars). CONCLUSIONS: In patients with severely reduced left ventricular function, TCI and MCI of propofol in combination with remifentanil showed similar hemodynamics. TCI patients needed inotropic support more often than MCI-treated patients. Although extubation time was longer in TCI patients and costs were higher, both anesthesia techniques can be recommended for early extubation after implantation of a cardioverter-defibrillator.     

Propofol anaesthesia via target controlled infusion or manually controlled infusion: effects on the bispectral index as a measure of anaesthetic depth.

Target controlled infusions (TCI) of propofol allow anaesthetists to target constant blood concentrations and respond promptly to signs of inappropriate anaesthetic depth. Studies comparing propofol TCI with manually controlled infusion (MCI) reported similar control of anaesthesia, but did not use an objective measure of anaesthetic depth. We therefore tested whether the Bispectral Index (BIS), an electroencephalographic (EEG) variable, is more stable during propofol TCI or MCI. Forty patients received midazolam and fentanyl before induction and were randomized to TCI or MCI. Target propofol concentrations in the TCI group were 3 to 8 microg/ml. The MCI group received propofol bolus (approximately 2 mg/kg) and infusion (3 to 10 mg/kg/h). Neuromuscular blockade was achieved with rocuronium. Following endotracheal intubation, nitrous oxide (66%) in oxygen was delivered and propofol infusion and fentanyl boluses were titrated against clinical signs. Blood pressure, heart rate and EEG were recorded, although the anaesthetist was blind to BIS values. The ideal BIS for general anaesthesia was defined as 50. Performance error, absolute performance error, wobble and divergence of BIS, and maximum changes in blood pressure and heart rate were compared using two-sample t-tests or rank-sum tests where appropriate. There was no difference in absolute performance errors during maintenance of anaesthesia with propofol TCI or MCI (23 +/- 11% vs 23 +/- 9%; P=0.97). The two groups did not differ significantly in performance error, wobble, divergence on haemodynamic changes. We conclude that TCI and MCI result in similar depth of anaesthesia and haemodynamic stability when titrated against traditional clinical signs.     

Bispectral index in patients with target-controlled or manually-controlled infusion of propofol

In this prospective, randomized study we compared bispectral index (BIS), hemodynamics, time to extubation, and the costs of target-controlled infusion (TCI) and manually-controlled infusion (MCI) of propofol. Forty patients undergoing first-time implantation of a cardioverter-defibrillator were included. Anesthesia was performed with remifentanil (0.2-0.3 micro g. kg(-1). min(-1)) and propofol. Propofol was used as TCI (plasma target concentration, 2.5-3.5 micro g/mL; n = 20) or MCI (3.0-4.0 mg. kg(-1). h(-1); n = 20). BIS, heart rate, and arterial blood pressure were measured at six data points: T1, before anesthesia; T2, after intubation; T3, after skin incision; T4, after first defibrillation; T5, after third defibrillation; and T6, after extubation. There were no significant hemodynamic differences between the two groups. BIS was significantly lower at T3 and T4 in the TCI group than in the MCI group. The mean dose of propofol was larger in TCI patients (5.8 +/- 1.4 mg. kg(-1). h(-1)) than in the MCI patients (3.7 +/- 0.6 mg. kg(-1). h(-1)) (P < 0.05), whereas doses of remifentanil did not differ. Time to extubation did not differ between the two groups (TCI, 13.7 +/- 5.3 min; MCI, 12.3 +/- 3.5 min). One patient in the MCI group had signs of intraoperative awareness without explicit memory after first defibrillation (BIS before shock, 49; after shock, 83). Costs were significantly less in the MCI group (34.83 US dollars) than in the TCI group (39.73 US dollars). BIS failed to predict the adequacy of anesthesia for the next painful stimulus. IMPLICATIONS: In this prospective, randomized study, bispectral index (BIS), hemodynamics, time to extubation, and costs of target-controlled infusion (TCI) and manually-controlled infusion of propofol were compared. TCI increased the amount of propofol used. BIS failed to predict the adequacy of anesthesia for the next painful stimulus.     

依托咪酯靶控输注在全胸腔镜二尖瓣置换术中的应用

目的观察依托咪酯靶控输注(TCI)在全胸腔镜二尖瓣置换术中的使用效果及安全性。方法选择拟在全胸腔镜下行二尖瓣置换术的风湿性二尖瓣病变患者110例,男48例,女62例,年龄29~55岁,ASAⅡ或Ⅲ级,随机分为依托咪酯TCI组(E组)和丙泊酚TCI组(P组),每组55例。E组使用依托咪酯-舒芬太尼TCI(依托咪酯初始血浆靶浓度为0.2μg/ml,根据BIS值以0.1μg/ml梯度逐步增加,舒芬太尼效应室靶浓度1.0ng/ml)进行麻醉诱导与维持,P组使用丙泊酚-舒芬太尼TCI(丙泊酚初始血浆靶浓度为1.0μg/ml,根据BIS值以0.3μg/ml梯度逐步增加,舒芬太尼效应室靶浓度1.0ng/ml)进行麻醉诱导与维持。记录两组患者诱导期低血压发生情况、诱导期血管活性药物用量、诱导期睫毛反射消失时间、麻醉期舒芬太尼用量、手术时间、体外循环时间、升主动脉阻断时间、入CCU时APACHE II评分、术后24h正性肌力药物评分、术后清醒时间、机械通气时间、CCU停留时间、术后住院时间、记录术前、术后2、6、24h血浆中血糖、乳酸浓度,术前及术后24h血浆皮质醇、醛固酮、ACTH浓度以及术后并发症情况。结果 E组患者诱导期低血压发生率明显低于P组,诱导期去甲肾上腺素用量明显少于P组(P0.05);E组清醒时间、机械通气时间、CCU停留时间、术后住院时间明显短于P组(P0.05);与术前比较,术后2、6、24h两组患者血糖和乳酸浓度明显升高(P0.05),6h达到高峰,24h开始下降,两组患者各时点血糖、乳酸浓度差异无统计学意义;与术前比较,术后24hP组皮质醇浓度明显升高(P0.05);术后24hP组皮质醇和醛固酮浓度明显高于E组(P0.05);两组ACTH浓度差异无统计学意义;E组院内肺部感染发生率明显低于P组(P0.05)。结论依托咪酯靶控输注可以维持麻醉诱导期血流动力学平稳,患者术后恢复时间明显缩短,术后肺部感染发生率明显降低,能安全应用于全胸腔镜二尖瓣置换术。     

丙泊酚靶控输注用于内窥镜逆行胰胆管造影的麻醉

目的 比较丙泊酚靶控输注与恒速输注用于内窥镜逆行胰胆管造影麻醉的效果差异.方法 选择接受内窥镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)患者67例,随机分为靶控组(n=35)与恒速组(n=32). 麻醉开始予芬太尼1μg/kg静脉注射,靶控组以丙泊酚按血浆靶浓度3 mg/L～6 mg/L诱导.待成功入镜后减至诱导浓度的1/2维持,必要时每次增减0.5 mg/L来加深或减浅麻醉;微泵组以丙泊酚1.5 mg/kg～2.5 mg/kg手工匀速推注至睫毛反射消失为诱导量,入镜后减至6mg·kg~(-1)·h~(-1)～9mg·kg~(-1)·h~(-1)泵注维持.两组均以术中体动反应调节麻醉深度.记录两组内泊酚总用量、手术时间、患者入睡时间、苏醒时间、不良事件发生率及术者、患者满意度并作统计分析.结果 靶控组呼吸抑制例数较少,术者满意度较高,差异有统计学意义.结论 靶控输注丙泊酚用于内窥镜逆行胰胆管造影麻醉呼吸抑制发生率低,靶浓度数值便于经验交流,操作简便.值得推广.