闭环靶控系统启动精准麻醉在老年病人无痛肠镜检查中的初步应用

凌云志; 刘刚; 孙宜云; 李晓红; 梁启胜; 黄元云

doi:10.13898/j.cnki.issn.1000-2200.2019.11.006

闭环靶控系统启动精准麻醉在老年病人无痛肠镜检查中的初步应用

Application value of closed-loop target control system to activate precise anesthesia in painless enteroscopy of elderly patients

摘要

摘要:
目的探讨闭环靶控系统启动精准麻醉在无痛肠镜检查中的应用价值。
方法拟行无痛肠镜检查病人40例，ASAⅠ~Ⅱ级，年龄60~75岁，男22例，女18例，按随机数字表法分为2组：观察组（S组）和对照组（D组），每组20例。S组闭环靶控输注丙泊酚，设定血浆靶控浓度为6μg/mL，目标脑电双频指数（BIS值）为55±5；D组静脉注射丙泊酚2~3 mg/kg，观察并比较2组术中HR、MAP、SpO₂、BIS值，苏醒时间、术中丙泊酚用量、镇静/麻醉后离院评分以及围术期不良反应的发生。
结果2组病人在麻醉后MAP及HR均降低（P < 0.01），S组在麻醉后BIS值降低（P < 0.01），BIS值稳定于55左右；组间比较D组MAP降低、HR减慢较S组更为明显（P < 0.01）。D组SpO₂在麻醉后降低（P < 0.01），且低于S组（P < 0.01）。S组病人术中丙泊酚用量以及苏醒时间均明显低于D组（P < 0.01），2组镇静/麻醉后离院评分差异无统计学意义（P>0.05），2组病人围术期不良反应的发生率差异无统计学意义（P>0.05）。
结论在无痛肠镜检查中闭环靶控系统启动精准麻醉的应用，可明显减少丙泊酚用量，缩短苏醒时间，能更好地维持术中循环和呼吸功能平稳，病人术后更为舒适，是一种值得推广的安全有效的无痛肠镜麻醉方法。

Abstract:
ObjectiveTo explore the application value of closed-loop target control system to activate precise anesthesia in painless enteroscopy.
MethodsForty patients scheduled by painless enteroscopy, ASA Ⅰ-Ⅱ, aged 60-75 years, 22 males and 18 females, were randomly divided into the observation group(group S) and control group(group D) (20 cases in each group).The group S was treated with closed-loop target-controlled infusion of propofol with a target-controlled plasma concentration for 6μg/mL and BIS value for (55±5).The group D was treated with intravenous injection of propofol with 2 to 3 mg/kg.The HR, MAP, SpO₂, BIS values, recovery time, propofol dosage during operation, departure score after sedation/anesthesia and perioperative adverse reactions were observed and compared between two groups.
ResultsAfter anesthesia, the levels of MAP and HR in two groups decreased(P < 0.01), the BIS value in group S decreased(P < 0.01), and was stable at about 55.Compared with the group S, the MAP decreasing and HR slowering in group D were more obvious in group S(P < 0.01).The SpO₂ in group D decreased after anesthesia(P < 0.01), and which was lower than that in group S(P < 0.01).The propofol dosage and recovery time in group S were significantly lower than those in group D(P < 0.01).There was not statistical significance in departure score after sedation/anesthesia between two groups(P>0.01). There was not statistical significance in the incidence rate of perioperative adverse reactions between two groups(P>0.01).
ConclusionsThe application of closed-loop target control system in precise anesthesia during painless enteroscopy can significantly reduce the dosage of propofol, shorten the recovery time, maintain the stabliation of intraoperative circulation and respiratory function, and make patients more comfortable after operation.It is a safe and effective method of painless enteroscopy anesthesia, and worthy of promotion.

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