摘要
目的:探讨基于脑电双频指数(BIS)反馈下的非肌松闭环靶控镇静麻醉改良方式在输尿管结石手术中的应用效果。方法:选取接受输尿管结石手术的60例患者,按照随机数字表法分为对照组与试验组,术前两组均采用相同的麻醉方法,对照组实施丙泊酚恒速输注,试验组实施丙泊酚闭环靶控镇静,监测患者入室后(T_(0))、诱导后(T_(1))、置入喉罩后(T_(2))、输尿管镜置入尿道后(T_(3))、钬激光碎石时(T_(4))、拔除喉罩后(T_(5))的平均动脉压(MAP)、心率(HR)、BIS值;记录丙泊酚、罗库溴铵用量、麻醉药物调控次数,患者苏醒情况及围术期不良事件发生情况。结果:两组手术时间、术中出血量、补液量、围术期不良事件发生率(10.00%与3.33%)比较差异均无统计学意义(均P>0.05)。试验组T_(0)、T_(1)、T_(2)、T_(3)、T_(5)时MAP均低于对照组,T_(5)时HR低于对照组,T_(1)时BIS值低于对照组,T_(5)时BIS值高于对照组,两组比较差异均有统计学意义(均P<0.05)。试验组罗库溴铵用量较对照组少,调节丙泊酚、瑞芬太尼次数较对照组少,两组比较差异具有统计学意义(均P<0.05)。试验组术毕-拔管时间、恢复室停留时间均少于对照组,拔管后1 min肌力情况级别高于对照组,苏醒质量评分高于对照组,两组比较差异具有统计学意义(均P<0.05)。结论:基于BIS反馈下的非肌松闭环靶控镇静应用于输尿管结石手术,麻醉效果好、患者血压波动小,可加速手术室间周转率、提高恢复室利用率,亦可节约人力。
Objective:To investigate the application effect of non-muscle release closed-loop target-controlled sedation and anesthesia based on Bispectral Index(BIS)feedback in ureteral calculi surgery.Methods:Sixty patients who received ureteral calculi operation were selected and divided into control group and experimental group according to random number table method.The two groups were given the same anesthesia method before surgery,the control group received constant infusion of propofol,and the experimental group was given closed-loop target controlled sedation with propofol.The mean arterial pressure(MAP),heart rate(HR)and BIS values were monitored after entry(T 0),induction(T 1),placement of laryngeal mask(T 2),ureteroscopy placement of urethra(T 3),holmium laser lithotripsy(T 4)and removal of laryngeal mask(T 5).The dosage of propofol and rocuronium bromide,regulation times of anesthetic drugs,patients’recovery and perioperative adverse events were recorded.Results:There were no significant differences in operation time,blood loss,fluid replacement amount and perioperative adverse event incidence between the two groups(10.00%vs.3.33%,P>0.05).The MAP of the experimental group at T 0,T 1,T 2,T 3 and T 5 were lower than those of the control group,the HR at T 5 was lower than that of the control group,the BIS value at T 1 was lower than that of the control group,and the BIS value at T 5 was higher than that of the control group(all P<0.05).The dosage of rocuronium bromide in the experimental group was less than that in the control group,and the regulation times of propofol and remifentanil were less than that in the control group(all P<0.05).The time from operation to extubation and the stay time in recovery room of the experimental group were less than those of the control group,the muscle strength level 1 minute after extubation was higher than that of the control group,and the score of recovery quality was higher than that of the control group(all P<0.05).Conclusion:The application of non-muscle release closed-loop target-controlled sedation based on BIS feedback in the surgery of ureteral calculi has good anesthetic effect and small blood pressure fluctuation,which can accelerate the turnover rate of operating room,improve the utilization rate of recovery room,and save manpower.
作者
张伟东
李永刚
张丹
杨丽娜
贾浩娟
ZHANG Weidong;LI Yonggang;ZHANG Dan;YANG Lina;JIA Haojuan(Department of Anesthesiology,Beijing Jingmei Group General Hospital,Beijing 102300,China)
出处
《陕西医学杂志》
CAS
2023年第8期1047-1050,共4页
Shaanxi Medical Journal
基金
北京市科技计划项目(D101401847591364)
北京京煤集团总医院院级科研基金资助项目(2021-02)。
关键词
输尿管结石
麻醉
脑电双频指数
非肌松药物
闭环靶控镇静
丙泊酚
Ureteral calculi
Anesthesia
Bispectral index
Non-muscle relaxants
Closed-loop target-controlled sedation
Propofol
