中国医科大学学报

中国医科大学学报
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中国医科大学学报 ›› 2017, Vol. 46 ›› Issue (8): 746-749.doi: 10.12007/j.issn.0258-4646.2017.08.017

• 论著 • 上一篇    下一篇

闭环与开环靶控输注在妇科腔镜手术中的应用比较

穆莹,刘丽丹,梁晨曦,冯静,张宁,吴秀英   

  1. 中国医科大学附属盛京医院麻醉科,沈阳 110004
  • 收稿日期:2016-12-05 出版日期:2017-08-30 发布日期:2017-08-24
  • 通讯作者: 吴秀英 E-mail:wuxy@sj?hospital.org
  • 作者简介:穆莹(1992 -),女,硕士研究生 .

Comparing Closed- and Open-loop Control Anesthesia Infusion in Gynecological Laparoscopic Operation

MU Ying,LIU Lidan,LIANG Chenxi,FENG Jing,ZHANG Ning,WU Xiuying   

  1. Department of Anesthesiology,Shengjing Hospital,China Medical University,Shenyang 110004,China
  • Received:2016-12-05 Online:2017-08-30 Published:2017-08-24

摘要: 目的 比较脑电双频指数(BIS)指导下丙泊酚复合瑞芬太尼闭环及开环靶控输注在妇科腹腔镜手术中的应用效果。方法 选取中国医科大学附属盛京医院行择期妇科腹腔镜手术患者 40 例,随机分为闭环靶控组(Ⅰ组,n =19)及开环靶控组(Ⅱ 组,n =21)。2 组患者入室后常规监测各项生命体征及 BIS,均采取静脉诱导方式,Ⅰ组根据 BIS 静脉输液泵自动反馈调节丙泊 酚效应室浓度,Ⅱ组根据 BIS 手动调节丙泊酚效应室浓度。分别记录气腹前(T0)、气腹后 5 min(T1)、气腹后 15 min(T2)、气腹 后 30 min(T3)、排出气腹后 10 min(T4)、离室(T5)的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度、BIS 值,记录 2 组术后拔管 时间及药物使用情况,同时进行 Ramsay 镇静评分并询问患者的主观舒适程度。结果 Ⅰ组患者拔管时间少于Ⅱ组(P < 0.01); Ⅰ组丙泊酚总使用量低于Ⅱ组(P < 0.05),瑞芬太尼使用量 2 组对比差异无统计学意义(P > 0.05);Ⅰ组患者 HR 较Ⅱ组更稳定, 但 MAP 波动较大;拔管后 Ramsay 镇静评分 2 组无统计学差异,Ⅰ组主观舒适度好于Ⅱ组(P < 0.05)。结论 妇科腹腔镜手术中 应用丙泊酚闭环靶控输注安全性高、可控性好、患者满意度高,且更节省药物,值得在临床上推广。

关键词: 脑电双频指数, 闭环靶控输注, 开环靶控输注, 妇科腹腔镜手术

Abstract: Objective To evaluate and compare the effectiveness of propofol-remifentanil closed-loop and open-loop anesthesia in gynecological laparoscopic operation under bispectral index(BIS)monitoring. Methods Forty female patients undergoing elective gynecological laparoscopic operation were recruited and randomly divided into closed-loop(groupⅠ)and open-loop(groupⅡ)groups. During anesthesia maintenance,the closed-loop group was administered with a BIS-feedback system to regulate the target effect-site concentration;whereas,the open-loop group was administered the target effect-site concentration according BIS value manually. The variation of non-invasive mean arterial pressure(MAP),heart rate(HR),SpO2,BIS,extubation time,consumption of propofol and remifentanil,Ramsay index,and subjective comfort grade were recorded at the selected time points. Results The extubation time in groupⅠwas shorter than in groupⅡ. The total dosage of propofol administered in groupⅠ was less than that in groupⅡ,but there was no significant difference in the total consumption of remifentanil. HR in groupⅠwas steadier than in groupⅡ. However,the MAP and Ramsay index were similar in both the groups. The subjective comfort grade in groupⅠwas higher than in group Ⅱ. Conclusion The use of propofol-remifentanil closed-loop system by BIS-feedback anesthesia is safer,more controllable,with higher degree of satisfaction and sparing side-effects,we therefore recommend it during gynecological laparoscopic operations.

Key words: bispectral index, closed-loop control infusion, open-loop control infusion, gynecological laparoscopic operation

中图分类号: 

  • R614.2
[1] 朱俊超,白文娅,滕秀飞,杨延超,李阳. 经皮穴位电刺激对妇科腹腔镜手术围拔管期应激反应的影响[J]. 中国医科大学学报, 2016, 45(2): 154-157.
[2] 李真,金宁,万静洁,李阳,万玉骁,朱俊超. 脑电双频指数监测小儿丙泊酚复合瑞芬太尼静脉麻醉维持剂量的临床研究[J]. 中国医科大学学报, 2016, 45(1): 17-20.
[3] 高光洁,乔娇,宋丹丹. 儿童全凭静脉麻醉在脑电双频指数指导下气管拔管的临床观察[J]. 中国医科大学学报, 2015, 44(7): 614-617.
[4] 周南,赵芳坤,周锦. 右美托咪啶对老年颅内肿瘤手术患者麻醉诱导期血流动力学和脑电双频指数的影响[J]. 中国医科大学学报, 2014, 43(9): 818-820.
[5] 罗小秀,吴秀英. 不同剂量右美托咪啶复合丙泊酚全凭静脉麻醉用于妇科腹腔镜手术的临床观察[J]. 中国医科大学学报, 2013, 42(2): 179-182.
[6] 贾慧,裴凌. 靶控输注和手控输注丙泊酚在喉罩应用中的对比[J]. 中国医科大学学报, 2013, 42(10): 931-931.
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