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随着麻醉数字化、人工智能化的快速发展,使用自动控制技术,将精准麻醉控制变成了现实。近来,我们应用闭环靶控系统启动精准麻醉在老年病人中进行无痛肠镜检查。在无痛肠镜检查操作中,丙泊酚是最常使用的一种药物,起效快,半衰期短,镇静作用强,然而如果使用药物剂量过大、手工推注速度过快及麻醉深度掌握不严格的情况下,极易导致病人血流动力学的剧烈波动和呼吸功能严重抑制,尤其对于老年病人,往往伴有心、脑血管疾病,更要引起足够重视,因此在严密监测病人一般生命体征的基础上,有必要进行麻醉深度监测。本研究采用了丙泊酚闭环靶控输注技术应用于老年病人无痛肠镜中,麻醉深度监测以脑电双频指数(BIS)为指标,检查过程中靶控丙泊酚输注系统自动进行调整,实现了人机对话,为精准麻醉控制提供可能性。
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2组病人的年龄、性别、体质量及无痛肠镜检查时间等指标差异均无统计学意义(P>0.05)(见表 1)。
分组 n 年龄/岁 男 女 体质量/kg 肠镜检查时间/min D组 20 64.45±3.47 11 9 60.45±5.38 25.80±2.35 S组 20 63.45±4.12 11 9 59.20±2.95 25.90±1.86 t — 0.83 0.00* 0.91 0.15 P — >0.05 >0.05 >0.05 >0.05 *示χ2值 表 1 2组病人的一般情况比较(x±s)
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与T0相比较,2组病人在T1、T2时间点MAP均降低(P < 0.01),HR减慢(P < 0.01),S组在T1、T2时间点BIS值降低(P < 0.01),BIS值稳定于55左右;在T3时间点2组病人HR、SpO2恢复至T0时水平(P>0.05),S组BIS值也恢复至T0时水平(P>0.05)。其中,D组在T1、T2时间点MAP降低、HR减慢较S组更明显(P < 0.01)。D组在T1时间点SpO2明显低于S组(P < 0.01)(见表 2)。
指标 分组 n T0 T1 T2 T3 F P MS组内 MAP D组 20 89.30±3.61 72.05±1.54** 73.00±1.81** 86.50±2.06**△△## 255.91 < 0.01 5.731 S组 20 91.45±2.93 76.30±1.30** 75.90±1.65** 86.65±1.50**△△## 270.97 < 0.01 3.812 t — 2.00 10.38 6.10 0.31 — — — P — < 0.05 < 0.01 < 0.01 >0.05 — — — HR D组 20 86.75±3.13 68.45±3.12** 70.00±3.08** 86.25±2.36△△## 299.19 < 0.01 8.647 S组 20 87.25±3.31 74.70±2.74** 75.30±2.56** 86.00±2.36△△## 140.84 < 0.01 7.647 t — 0.42 6.95 7.53 0.35 — — — P — >0.05 < 0.01 < 0.01 >0.05 — — — SpO2 D组 20 98.00±1.34 94.05±1.15** 96.60±2.11**△ 98.10±1.17△△ ## 31.93 < 0.01 2.235 S组 20 97.65±1.27 96.40±1.14** 97.40±1.50△ 97.85±0.99△△ 7.08 < 0.01 1.536 t — 0.79 6.32 1.33 0.69 — — — P — >0.05 < 0.01 >0.05 >0.05 — — — BIS S组 20 92.10±1.97 54.85±1.46** 55.25±1.25** 91.45±2.33△△ ## 2678.124 < 0.01 3.251 q检验:与T0时间点比较**P < 0.01;与T1时间点比较△P < 0.05, △△P < 0.01;与T2时间点比较##P < 0.01 表 2 2组病人不同时间点的MAP、HR、SpO2、BIS值比较(x±s)
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病人术中丙泊酚用量和苏醒时间S组均明显低于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)(见表 3)。
分组 n 术中丙泊酚用量/mg 苏醒时间/min 镇静/麻醉后离院评分/分 D组 20 160.75±8.90 8.40±0.77 9.00±0.73 S组 20 127.45±3.79 5.53±0.73 9.30±0.57 t — 15.40 12.08 1.45 P — < 0.01 < 0.01 >0.05 表 3 2组病人术中丙泊酚用量、苏醒时间及镇静/麻醉后离院评分比较(x±s)
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2组病人在术中体动、术后头晕、术后恶心呕吐、术中呼吸抑制的发生率方面差异均无统计学意义(P>0.05)(见表 4)。
分组 n 术中体动 术后头晕 术后恶心、
呕吐术中呼吸抑制 D组 20 2(10.00) 3(15.00) 1(5.00) 3(15.00) S组 20 1(5.00) 2(10.00) 1(5.00) 1(5.00) χ2 — 0.00 0.00 0.53 0.28 P — >0.05 >0.05 >0.05 >0.05 表 4 2组病人围术期不良反应比较[n;百分率(%)]
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
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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. -
表 1 2组病人的一般情况比较(x±s)
分组 n 年龄/岁 男 女 体质量/kg 肠镜检查时间/min D组 20 64.45±3.47 11 9 60.45±5.38 25.80±2.35 S组 20 63.45±4.12 11 9 59.20±2.95 25.90±1.86 t — 0.83 0.00* 0.91 0.15 P — >0.05 >0.05 >0.05 >0.05 *示χ2值 表 2 2组病人不同时间点的MAP、HR、SpO2、BIS值比较(x±s)
指标 分组 n T0 T1 T2 T3 F P MS组内 MAP D组 20 89.30±3.61 72.05±1.54** 73.00±1.81** 86.50±2.06**△△## 255.91 < 0.01 5.731 S组 20 91.45±2.93 76.30±1.30** 75.90±1.65** 86.65±1.50**△△## 270.97 < 0.01 3.812 t — 2.00 10.38 6.10 0.31 — — — P — < 0.05 < 0.01 < 0.01 >0.05 — — — HR D组 20 86.75±3.13 68.45±3.12** 70.00±3.08** 86.25±2.36△△## 299.19 < 0.01 8.647 S组 20 87.25±3.31 74.70±2.74** 75.30±2.56** 86.00±2.36△△## 140.84 < 0.01 7.647 t — 0.42 6.95 7.53 0.35 — — — P — >0.05 < 0.01 < 0.01 >0.05 — — — SpO2 D组 20 98.00±1.34 94.05±1.15** 96.60±2.11**△ 98.10±1.17△△ ## 31.93 < 0.01 2.235 S组 20 97.65±1.27 96.40±1.14** 97.40±1.50△ 97.85±0.99△△ 7.08 < 0.01 1.536 t — 0.79 6.32 1.33 0.69 — — — P — >0.05 < 0.01 >0.05 >0.05 — — — BIS S组 20 92.10±1.97 54.85±1.46** 55.25±1.25** 91.45±2.33△△ ## 2678.124 < 0.01 3.251 q检验:与T0时间点比较**P < 0.01;与T1时间点比较△P < 0.05, △△P < 0.01;与T2时间点比较##P < 0.01 表 3 2组病人术中丙泊酚用量、苏醒时间及镇静/麻醉后离院评分比较(x±s)
分组 n 术中丙泊酚用量/mg 苏醒时间/min 镇静/麻醉后离院评分/分 D组 20 160.75±8.90 8.40±0.77 9.00±0.73 S组 20 127.45±3.79 5.53±0.73 9.30±0.57 t — 15.40 12.08 1.45 P — < 0.01 < 0.01 >0.05 表 4 2组病人围术期不良反应比较[n;百分率(%)]
分组 n 术中体动 术后头晕 术后恶心、
呕吐术中呼吸抑制 D组 20 2(10.00) 3(15.00) 1(5.00) 3(15.00) S组 20 1(5.00) 2(10.00) 1(5.00) 1(5.00) χ2 — 0.00 0.00 0.53 0.28 P — >0.05 >0.05 >0.05 >0.05 -
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