喉罩联合靶控和手控输注丙泊酚的临床观察

摘要

目的：应用喉罩和脑电双频指数( BIS)监测,观察靶控输注和手控输注丙泊酚的临床效果。方法30例ASA Ⅰ~Ⅱ级乳腺癌患者拟在全麻下行乳腺改良根治术,随机分为靶控( T组)和手控( M组)组输注丙泊酚。 T组效应室靶浓度为6μg/mL,M组诱导剂量为2．5 mg/kg,初始维持速度5 mg/( kg·h),复合靶控输注效应室靶浓度为4 ng/mL瑞芬太尼。维持BIS值在40~60之间,维持平均动脉压( MAP)在基础值的20%左右。比较两组用药量以及入室(T0)、诱导开始(T1)、置入喉罩即刻(T2)、置入完毕(T3)、切皮(T4)、停药(T5)、术毕( T6)、睁眼( T7)、自主呼吸恢复( T8)、指令动作恢复( T9)、拔除喉罩( T10)各时刻MAP、心率( HR)及BIS的变化。结果 T组丙泊酚用量高于M组(P=0．005),瑞芬太尼用量差异无统计学意义(P>0．05)；术中异常血压发生率差异无统计学意义(P>0．05)；T4时,T组BIS值低于M组(39．80±9．62 vs.53．07±8．37,P=0．00)；T2、T3时,T组 MAP 均低于 M 组(P =0．002,P =0．009)；与 T1相比,T 组在 T2~T5时,MAP 明显降低(P <0．05),T2~T7时,HR明显降低(P<0．05),T2~T10时,BIS值明显降低(P<0．05)；M组在T3和T4时,MAP明显降低(P<0．05),T10时,HR明显升高(P<0．05),T2~T7时,BIS值明显降低(P<0．05)。结论在BIS监测的麻醉深度下,TCI和MCI丙泊酚都能满足置入喉罩的麻醉需要,具有良好的可控性；与手控输注相比,喉罩联合靶控输注丙泊酚用量偏大,血流动力学波动较大,麻醉深度较确切。%Objective To compare the efficacy of laryngeal mask airway ( LMA) combined with propofol of target controlled infusion ( TCI) and manually controlled infusion ( MCI) ,under the monitoring on depth of anaesthesia by bispectral index (BIS). Methods Thirty patients scheduled for modified radical mastectomy were randomly allo-cated as target controlled infusion group (group T) and manually controlled infusion group (group M),group T re-ceived TCI propofol 6 μg/mL with LMA, while group M received the standard bolus of propofol 2. 5 mg/kg and 5 mg/( kg·h) maintained,as well as the TCI remifentanil 4 ng/mL. The BIS was maintained 40~60 and the mean ar-terial pressure ( MAP) was within 20% of baseline. The drug consumption was recorded. The MAP,heart rate ( HR) , BIS score were compared at the time point of baseline ( T0 ) , induction ( T1 ) , insertion ( T2 ) , completing insertion ( T3 ) ,incision ( T4 ) ,withdrawal ( T5 ) ,end of operation ( T6 ) ,open eyes ( T7 ) ,spontaneously breath( T8 ) ,instruction ( T9 ) ,extubation ( T10 ) between the two groups. Results There was no significant difference between the two groups in remifentanil doses. The propofol consumption in group T was more than that of group M (P<0. 01). There was no significant difference between the two groups in the incidence of abnormal MAP. The BIS score at T4 in group T was lower than that of group M (39. 80 ± 9. 62 vs. 53. 07 ± 8. 37,P<0. 01). The MAP at T2 and T3 in group T (66. 33 ± 11. 51,67. 13 ± 9. 16) were significantly lower than those of group M (82. 20 ± 14. 23,76. 00 ± 8. 13),there were sig-nificant differences (P<0.01).In group T,compared with T1,the MAP was lower at T2 ~T5(P <0.05),HR was lower at T2 ~T7(P<0. 05),BIS was lower at T2 ~T10(P<0. 05). In group M,compared with T1,the MAP was low-er at T3 and T4(P<0. 05),HR was higher at T10(P<0. 05),BIS was lower at T2 ~T7(P<0. 05). Conclusion Both TCI and MCI propofol administrations are associated with good controllability and could possibly satisfy the LMA in-sertion during BIS controlled on depth of anaesthesia. TCI cost more propofol than MCI with more variability in haemo-dynamics but precise depth of anesthesia during the procedure.