腹腔镜结直肠手术中滴定靶控输注麻醉的应用

目的探讨以脑电双频指数（B1S）和收缩压为滴定目标、以丙泊酚复合瑞芬太尼滴定靶控输注静脉麻醉对腹腔镜结直肠手术中麻醉用药量和麻醉深度的影响。方法选择60例择期腹腔镜结直肠手术患者为研究对象，采用丙泊酚复合瑞芬太尼滴定靶控输注静脉麻醉，以BIS维持40～60、收缩压波动不超过基础值的20％为目标，滴定调节两种药物的血浆靶浓度，当BIS与收缩压的变化趋势出现矛盾时首先调节SBP。记录不同时间点的BIS、血压及麻醉药血浆靶控浓度等。结果麻醉诱导后血压基本平稳，BIS维持在60以内，其中在人工气腹建立后和Trendelenburg体位期间，BIS低至35。40之间：整个麻醉过程中患者均无术中知晓。麻醉期间存在手术刺激时，丙泊酚和瑞芬太尼血浆靶浓度的95％C1分别为2．55～2．65mg／L和4．09～4．26μg／L，其中丙泊酚的血浆靶浓度所推荐剂量。结论在腹腔镜结直肠手术中，以BIS结合收缩压为目标进行丙泊酚复合瑞芬太尼滴定靶控输注静脉麻醉，可维持有的麻醉深度，并减少麻醉药的用量。

Application of titrated target-controlled infusion anesthesia in laparoscopic colorectal surgery

Objective To evaluate the effect of titrated target-controlled infusion with propofol and remifentanil on anesthetics consumption and anesthesia depth in patients undergoing elective laparoscopie colorectal surgery. Methods Sixty ASA I -III patients for elective laparoscopic colorectal surgery were enrolled. Titrated target-controlled infusion （TCI） with propofol and remifentanil was performed. Plasma concentration of the drugs was administered by fitrated method to maintain bispectral index（BIS） in the range of 40-60 with systolic blood pressure（SBP） fluctuation within 20% of the basic value. BIS, SBP, plasma concentration of propofol and remifentanil were recorded at different time points. Awareness during operation was inquired postoperatively. Results During the entire anesthesia period, the blood pressure was stable and BIS was maintained less than 60. There was no awareness during operation. The plasma concentrations （95% confidence interval） for TCI of propofol and remifentanyl were 2.55-2.65 mg/L and 4.09-4.26 μg/L respectively when existing surgical stimulation during anesthesia, and the plasms target concentration of propofol was lower than the recommended dosages. Conclusion Titrated target-controlled infusions with propofol and remifentanil for elective laparoscopic colorectal surgery can maintain proper anesthesia depth and reduce the drug consumption.