瑞芬太尼和丙泊酚联合闭环靶控的临床应用

目的:探讨以脑电双频指数(BIS)、平均动脉压(MBP)、心率(HR)为闭环反馈指标行丙泊酚和瑞芬太尼联合闭环靶控的可行性。方法:40例年龄18~39a,拟行妇科腹腔镜择期手术病人随机分成2组,靶控组设丙泊酚3mg·L-1,瑞芬太尼4μg·L-1的浓度行诱导和维持;闭环靶控组设同样初始浓度,以BIS值(50~60),MBP(8~12kPa),HR(60~100次·min-1)为反馈指标在诱导和麻醉维持过程中进行靶控浓度的反馈调控,术中监测HR,MBP,BIS等指标。结果:术中BIS最高值靶控组为63.7±s2.8,明显高于闭环靶控组的53.3±2.0(P<0.01),且超出所设上限60。插管期靶控组MBP最低值低于闭环靶控组(P<0.05),且低于8kPa;切皮期靶控组MBP最高值明显高于闭环靶控组(P<0.01),且超过12kPa。切皮期靶控组HR最高值明显高于闭环靶控组(P<0.01)。结论:以BIS,MBP和HR作为反馈指标行丙泊酚和瑞芬太尼联合闭环靶控可以更好地维持血流动力学的稳定及适当的麻醉深度。

Application of closed-loop target controlled infusions of remifentanil and propofol in clinic

AIM:To study the possibility of propofol combined remifentanil closed-loop target controlled infusions (CLTCI) anesthesia with bispectral index (BIS), mean blood pressure ( MBP) and heart rate (HR) as feedback indexes. METHODS:Forty patients aged 18-39 a, scheduled for gynaecological laparoscopy were randomly divided into two groups, target controlled infusion (TCI) group(n=20) and CLTCI group(n=20). In TCI group the target concentrations of propfol and remifentanil were set at 3 mg· L -1 and 4 μg·L -1 respectivelil, maintaining throughout the anesthesia. In CLTCI group the target concentrations of propfol and remifentanil were set at 3 mg·L -1 and 4 μg·L -1 respectivelil at the initiation, then adjusted with the feedback system according to the indexes of BIS (50-60), MBP (8-12 kPa) and HR (60-100 bpm) which were monitored continuously for two groups during the operation. RESULTS: The highest value of BIS during operation in TCI group (63.7±s 2.8) was obviously higher than that in CLTCI group(53.3±2.0, P<0.01) exceeding the upper threshold of 60. The lowest value of MBP in TCI group during operation was statistically lower than that in CLTCI group(P<0.05), also lower than 8 kPa. The hemodynamic signs (HR, MBP) were more stable in CLTCI group than those in TCI group during operation. The dosage of propofol in TCI group was statistically higher than that in CLTCI group(P<0.05) and the dosage of remifentanil in CLTCI group was statistically higher than that in TCI group(P<0.01). CONCLUSION: Propofol and remifentanil CLTCI anesthesia with BIS, MBP and HR as feedback index has the advantages of more stable hemodynamics and more adjustable depth of anesthesia than propofol and remifentany TCI anesthesia.