摘要
目的比较镇痛-伤害性刺激指数(ANI)与脑电双频指数(BIS)指导下的瑞芬太尼复合丙泊酚TCI在腹腔镜胆囊切除术(LC)中的应用。方法采用前瞻性随机单盲对照研究,择期行LC患者120例,随机分为研究组(E组)和对照组(C组),每组60例。两组在BIS监测下行瑞芬太尼复合丙泊酚TCI,E组根据ANI调节阿片类药物用量;C组根据HR、BP调节阿片类药物用量。观察并记录HR>基础值120%发生率、MAP>基础值120%或<基础值80%发生率、艾司洛尔、阿托品、尼卡地平、复方乳酸钠和麻黄碱使用情况。记录停药后睁眼时间与拔出喉罩时间。观察拔除喉罩即刻、术后1、2hVAS评分;记录哌替啶、瑞芬太尼和丙泊酚用量;有无术中知晓,术后恶心、呕吐不良反应。结果与C组比较,E组HR>基础值120%发生率、艾司洛尔、阿托品和复方乳酸钠使用率明显降低(P<0.05);而术中MAP>基础值120%或<基础值80%的发生率、尼地卡平和麻黄碱使用率差异均无统计学意义;瑞芬太尼用量明显降低、睁眼时间和拔出喉罩时间明显缩短(P<0.05)两组拔除喉罩后即刻、术后1、2h的VAS评分,哌替啶、丙泊酚用量差异均无统计学意义。两组术后未发生恶心、呕吐不良反应,未出现术中知晓。结论丙泊酚复合瑞芬太尼靶控输注全麻下行腹腔镜胆囊切除术,在镇痛-伤害性刺激指数与脑电双频指数指导下比较经验用药,能有效减少循环波动,减少麻醉性镇痛药物的使用,缩短麻醉苏醒时间。
Objective To investigate the utility of the analgesia nociception index （AND guided remifentanil target adaption during BIS guided propofol TCI in laparoscopic cholecystectomy （LC）. Methods In this prospective randomized controlled study, a total of in one hundred and twenty adult patients undergoing general anesthesia of remifentanil-propofol TCI with the bispectral index （BIS） for LC were divided into two groups with 60 patients each. The administration of remifentanil were supervised by an additional monitor of ANI in the group experimental （group E）, while adjusted by the HR and MAP in the group control （group C）. The changes in MAP, HR, BIS, ANI, the dosage of anesthesia drugs, interventions of hemodynamic instabilities, time of open-eyes and extubation after surgery, VAS score, complementary analgesics, awareness, PONV were recorded. Results The occurrence of HR variation overrun 20 % baseline in the group E was significantly lower than that in the group C （P〈0.05）. The usage of esmolol, atropine, crystalloid volume expansion in the group E was significantly less than that in the group C （P〈0. 05）. The mean dosage of remifentanil in the group E was significantly lower than that in the group C （P〈0.05）. The time of open-eyes and extubation after surgery in group E was significantly less than that in group C （P〈0. 05）. Conclusion ANI guided general anesthesia of remifentanil target adaptation during BIS guided propofol TCI in LC can stabilize hemodynamics, optimize the usage of analgetics, and shorten the time of emergence.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2013年第9期867-869,共3页
Journal of Clinical Anesthesiology
