脑电双频指数指导下的丙泊酚闭环靶控输注系统在结直肠癌手术中的应用效果

目的 比较丙泊酚闭环靶控输注与开环手动调节输注用于结直肠癌术中麻醉的疗效差异。 方法 将2017年2月—2019年2月于台州市中心医院收治的110例结直肠癌手术患者按随机数字表法分为研究组(55例)和对照组(55例)。研究组予以BIS指导下丙泊酚闭环靶控输注麻醉,对照组予以丙泊酚开环输注麻醉。监测T1(麻醉诱导前)、T2(插管时)、T3(切皮时)、T4(术毕)和T5(拔管时)HR、MAP和SPO₂等血流动力学参数,记录手术时间、麻醉时间、丙泊酚用量、自主呼吸恢复时间、苏醒时间和拔管时间;观察不良反应;评价认知功能恢复情况。 结果 研究组T2~T4时刻MAP及T2时刻HR均高于对照组(均P<0.001),而研究组T3和T4时刻HR均低于对照组(均P<0.001)。研究组丙泊酚用量[(647.51±24.62)mg]低于对照组[(783.18±31.76)mg],自主呼吸恢复时间、苏醒时间和拔管时间均短于对照组(均P<0.001)。研究组术后1 d MMSE评分(26.69±1.32)高于对照组(24.95±1.46,t=3.802,P<0.001)。研究组不良反应发生率(9.09%)低于对照组(25.45%,χ2=5.153,P=0.023)。 结论 BIS指导下丙泊酚闭环靶控输注有利于维持结直肠癌患者术中血流动力学稳定,减少麻醉药物用量,缩短麻醉复苏时间,减轻不良反应,促进认知功能恢复。 

Clinical effect of propofol closed-loop target-controlled infusion system guided by bispectral index in colorectal cancer surgery

Objective To compare the efficacy of propofol closed-loop target-controlled infusion and open-loop manual regulated infusion in colorectal cancer surgery. Methods A total of 110 patients with colorectal cancer undergoing surgery were divided into study group(55 cases) and control group(55 cases) according to random number table method. The patients in the study group received intraoperative propofol infusion with closed-loop target-controlled infusion system guided by BIS, while the patients in the control group received intraoperative propofol infusion with manual adjustment. HR, MAP and SPO₂ were monitored on T1(before induction of anesthesia), T2(at intubation), T3(at skin incision), T4(after operation) and T5(at extubation) time points. The operation time, duration of anesthesia, dosage of propofol during anesthesia, recovery time of spontaneous breathing, time to recovery and extubation were recorded. The adverse reactions to anesthesia were observed. The recovery of cognitive function after anesthesia resuscitation were evaluated. Results The value of MAP at T2-T4 and HR at T2 in the study group was significantly higher than those in the control group( all P<0.01), while HR at T3 and T4 in the study group were significantly lower than that in the study group(all P<0.01). The dosage of propofol during anesthesia in the study group was(647.51±24.62)mg, which was significantly lower than that in the control group [(783.18±31.76)mg], and the recovery time of spontaneous breathing, recovery time and time to extubation were significantly shorter than those in the control group(all P<0.001). The MMSE score of the study group(26.69±1.32) was significantly higher than that of the control group(24.95±1.46) on the 1 st day after operation(t=-3.802, P<0.001). The overall incidence of adverse reactions to anesthesia in the study group(9.09%) was significantly lower than that in the control group(25.45%, χ2=5.153, P=0.023). Conclusion The closed-loop target-controlled infusion system of propofol under BIS guidance is more conducive to maintaining stability of the hemodynamic and depth of anesthesia, reducing the dosage of anesthetics, shortening the time of anesthesia resuscitation, reducing adverse reactions of anesthesia, promoting the recovery of cognitive function and improving the safety of anesthesia in patients undergoing colorectal cancer surgery.