不同靶浓度丙泊酚对腹腔镜胆囊切除术患者镇静深度与应激反应的影响

目的:通过靶控输注(target-controlled infusion,TCI)不同浓度丙泊酚,研究其对腹腔镜胆囊切除术患者脑电双频指数(bispectral index,BIS)和应激反应的影响。方法:随机将60例ASAⅠ级或Ⅱ级择期行腹腔镜胆囊切除术患者分为3组,每组20例,丙泊酚TCI靶浓度分别为2.5μg/ml(Ⅰ组)、3.5μg/ml(Ⅱ组)、4.5μg/ml(Ⅲ组)。于麻醉诱导前即刻(T1)、气管插管后3min(T2)、气腹后3min(T3)、气腹后30min(T4)、气管拔管后即刻(T5),记录BIS值和收缩压(systolic pressure,SP)、舒张压(diastolic pressure,DP)、心率(heart rate,HR),同期抽取桡动脉血测定血糖和血皮质醇。结果:3组患者一般情况、麻醉时间差异无统计学意义(P>0.05),Ⅲ组苏醒时间比Ⅰ组明显延长(P<0.05);Ⅰ组BIS值于T3、T4时平均(55.3±2.2),Ⅱ、Ⅲ组明显降低(P<0.05),分别为(46.5±3.1)和(41.8±1.4);与Ⅰ组比较,Ⅱ组各时点血糖和皮质醇值差异无统计学意义(P>0.05),Ⅲ组于T3~T5时血糖和皮质醇值明显降低(P<0.05)。结论:3组靶控浓度丙泊酚均能维持满意的镇静深度,靶浓度4.5μg/ml的丙泊酚对抑制腹腔镜手术应激反应更有效,但苏醒时间较长。

Effects of different target level of propofol on bispectral index and stress response in patients undergoing laparoscopic cholecystectomy

Objective:To investigate the influence of different doses of propofol on bispectral index(BIS) and stress response in patients undergoing laparoscopic cholecystectomy(LC).Methods:Sixty ASAⅠorⅡ patients undergoing LC were randomly divided into three groups(n=20):propofol target concentration in Ⅰ,Ⅱand Ⅲ group was 2.5μg/ml,3.5μg/ml and 4.5μg/ml.BIS,systolic pressure(SP),diastolic pressure(DP),heart rate(HR),blood glucose and cortisol in blood were measured immediately before induction of anesthesia(T1),3min after tracheal intubation(T2),at 3 and 30min after CO2 insufflation(T3,T4) and after extubation(T5).Results:There were no statistically significant differences in age,sex,body weight,duration of anesthesia among the 3 groups(P>0.05).The awakening time in group Ⅲ was longer than that in groupⅠ(P<0.05).The mean BIS values in group Ⅰ were kept at(55.3±2.2) at T3 and T4,which was obviously higher than that in group Ⅱ(46.5±3.1) and Ⅲ(41.8±1.4)(P<0.05).The difference in blood glucose and cortisol between group Ⅰ and Ⅱ at every time point was not statistically significant(P>0.05).The blood glucose and cortisol at T3,T4 and T5 in group Ⅲ were obviously lower than that in group Ⅰ(P<0.05).Conclusions:The three groups all obtained sufficient degree of sedation.Intravenous infusion of 4.5μg/ml propofol may significantly attenuate the stress response in LC,but the awakening time increases.