摘要目的 评价Narcotrend指数(NI)指导下丙泊酚-瑞芬太尼程控性闭环靶控输注麻醉用于腹腔镜胆囊切除术的效果.方法 择期腹腔镜胆囊切除术患者60例,性别不限,年龄20～64岁,BMI 18～25 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组(n=30):程序性调控组(P组)和人工调控组(A组).采用效应室模式进行靶控输注.选择丙泊酚初始靶浓度后根据公式确定瑞芬太尼靶浓度;A组根据麻醉医师经验人工调控丙泊酚靶浓度2 ～4 μg/ml和瑞芬太尼靶浓度3～4ng/ml.术中间隔5 min调控药物浓度,维持NI值26 ～ 46.记录麻醉诱导时间、丙泊酚和瑞芬太尼麻醉诱导剂量、平均维持剂量、初始、最高和最低靶浓度、平均NI值、NI值目标范围维持时间比率、苏醒时间以及HR或MAP波动超过基础值20％的发生情况和术中知晓情况.结果 2组均未见术中知晓发生.与A组比较,P组麻醉诱导时间缩短,瑞芬太尼诱导剂量增加,初始靶浓度升高,丙泊酚和瑞芬太尼的平均维持剂量和最低靶浓度降低,NI值目标范围维持时间比率升高,苏醒时间缩短(P＜0.05或0.01),丙泊酚诱导剂量和初始靶浓度、丙泊酚和瑞芬太尼最高靶浓度、平均NI值、HR或MAP波动超过基础值20％的发生率差异无统计学意义(P＞0.05).结论 对于腹腔镜胆囊切除术,NI指导下丙泊酚-瑞芬太尼程控性闭环靶控输注麻醉安全有效,精确化用药效果优于人工调控靶控输注法.

abstractsObjective To evaluate the efficacy of closed-loop coadministration of propofol and remifentanil guided by Narcotrend index (NI) in laparoscopic cholecystectomy.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 20-64 yr,with body mass index of 18-25 kg/m2,scheduled for elective laparoscopic cholecystectomy,were randomized into 2 groups (n =30 each):program regulation group (group P) and artificial regulation group (group A).After the initial target effect-site concentration of propofol was selected,the target effect-site concentration of remifentanil was determined according to the formula.In group A,the target effect-site concentrations of propofol (2-4 μg/ml) and remifentanil (3-4 ng/ml) were adjusted artificially according to anesthesiologists' experience every 5 min to maintain NI value at 26-46.Induction time,anesthesia induction and mean maintenance doses and the initial,highest and lowest target concentrations of propofol and remifentanil,mean NI value,percentage of time with NI between 26 and 46,emergence time,and development of fluctuation in heart rate or mean arterial pressure ＞ 20％ of the baseline value and intraoperative awareness were recorded.Results No intraoperative awareness was found in the two groups.Compared with group A,the induction time was significantly shortened,the induction dose and initial target concentration of remifentanil were increased,the mean maintenance dose and lowest target concentration of propofol and remifentanil were decreased,the percentage of time with NI between 26 and 46 was increased,and the emergence time was shortened (P＜0.05 or 0.01),and no significant change was found in the induction dose and initial target concentration of propofol,the highest target concentrations of propofol and remifentanil,mean NI value,or incidence of fluctuation in heart rate or mean arterial pressure ＞ 20％ of the baseline value in group P (P＞ 0.05).Conclusion For laparoscopic cholecystectomy,NI-guided closed-loop coadministration of propofol and remifentanil produces safe and effective anesthesia,and the efficacy of precise administration is superior to that of artificially regulated target-controlled infusion.