我国小儿丙泊酚靶控输注系统在小儿短小手术中的应用

目的 探讨我国新型小儿丙泊酚靶控输注系统应用于小儿短小手术的可行性,并与国外小儿Marsh系统比较.方法 90例美国麻醉医师协会体格情况分级Ⅰ级、3～5岁、择期行单侧腹股沟斜疝疝囊结扎术小儿,数字随机法分为L组(内嵌我国新型小儿丙泊酚药代学模型)和M组(国外小儿Marsh模型),每组45例.所有患儿术前不用镇静药,常规监测血压、心电图、脉搏血氧饱和度、脑电双频指数(BIS).两组分别以我国、国外两种药代模型行丙泊酚血浆靶控输注,初始目标血浆浓度为6 μg/ml,同时复合局部神经阻滞后开始手术.如切皮时发生明显体动则将血浆浓度上调1μg/ml,直至体动消失,最高至8 μg/ml,如仍有体动则停靶控输注改为吸入麻醉.监测诱导前(T_0)、麻醉诱导毕(T_1)、切皮时(T_2)、切皮后3 min(T_3)、5 min(T_4)和术毕时(T_5)的心率(HR)、收缩压(SBP)、舒张压(DBP)、呼吸频率(RR)和BIS值.记录丙泊酚各目标血浆靶控浓度以及吸人麻醉下完成手术的例数,术后苏醒时间和术中、术后并发症.结果 L组在靶控输注下及血浆浓度为6 μg/ml时可完成的手术例数多于M组(P＜0.01).T_1～T_4时点HR、SBP、DBP、RR和BIS值组内比较,L组差异无统计学意义,M组差异有统计学意义(P＜0.05);L组T_2～T_4时点上述指标均小于M组(P＜0.05或0.01).L组术中并发症少于M组(P＜0.05).结论 小儿短小手术同样应用血浆靶控输注丙泊酚6 μg/ml时,我国内嵌新型小儿丙泊酚药代系统较Marsh系统能较好地抑制应激反应,血流动力学平稳,并发症较少,符合临床要求.

Effect of the new propofol target controlled infusion system in children undergoing high ligation of hernial sac

Objective To discuss the effect of the new target controlled infusion(TCI)system in Chinese children undergoing minor operation and compared with TCI system with Marsh parameters.Methods Ninety ASA I,aged 3-5 yrs children undergoing elective unilateral high ligation of hernial sac under general anesthesia were randomly divided into group L(n=45)and group M(n=45)2 groups.All subjects were unpremedicated.Systolic blood pressure(SBP),diastolic blood pressure(DBP),ECG,SpO_2 and BIS were monitored.Patients of Group L and group M were anesthetized with propofol by Lian propofol TCI system and Marsh system respectively,combined with regional block.The target plasma concentration of TCI system was set at 6 μg/ml initially and up-regulated 1 μ/ml gradually if obvious body movement occurred while skin incision.If the target plasma concentration up to 8 μg/ml but there still had body movement,the TCI venous anesthesia was replaced by inhaled anesthesia.HR,RR,SBP,DBP and BIS were recorded in time points of baseline(T_0),after the induction(T_1),skin incision(T_2),3,5 min after skin incision(T_3,T_4),the end of operation(T_5).Complications,the awakening time and the number of cases which anesthetized with different propofol plasma concentrations or inhaled anesthesia were recorded respectively as well.Results The number of cases which completed the operation under TCI plasma concentration 6 μg/ml in group L were significantly more than those in group M(P ＜ 0.01).There were significantly different of T_1 -T_4 values of HR,RR,SBP,DBP and BIS in group M(P＜0.05),but not in group L.Compared with group L,T_2-T_4 values of HR,RR,SBP,DBP and BIS were higher in group M(P ＜ 0.05 or 0.01).Complications were lower in group L than those in group M.Conclusion Compared with Marsh system,propofol 6 μg/ml plasma concentration with the new target controlled infusion system applied in Chinese children undergoing unilateral high ligation of hernial sac could maintain stable hemodynamics,less stress reaction and complications.