数字化技术在高龄患者TCI麻醉中的应用  

Digital Technology in Elderly Patients with the Application of TCI Anesthesia

作　　者：颜景佳[1] 赵桀[1] 王雅端[1] 江长城[1] 

机构地区：[1]福建医科大学附属泉州第一医院麻醉科,福建省泉州市东街252号362000

出　　处：《中国数字医学》2012年第6期25-28,共4页China Digital Medicine

基　　金：福建省泉州市科技局科研基金(编号:2011Z61)~~

摘　　要：目的:探讨数字化技术在高龄患者TCI麻醉时的应用价值。方法:择期行腹部手术,ASA为Ⅱ-Ⅲ级的高龄患者60例,随机分为2组(n=30):TCI麻醉监测组(以下简称"T组")和对照组(以下简称"P组")。麻醉诱导均为芬太尼3.3μg/kg、咪唑安定0.05mg/kg、依托咪酯0.3mg/kg、顺阿曲库铵0.15mg/kg,诱导插管后T组采用血浆靶控TCI维持麻醉,术中根据AAI值调整丙泊酚和瑞芬太尼的TCI血浆浓度及应用肌松监测反馈仪闭环给予肌松药。丙泊酚的血浆靶浓度为2.32.8μg/ml,瑞芬太尼的血浆靶浓度为3.6-4.8ng/ml,顺阿曲库铵则是闭环给药;而P组只根据血压、脉搏和麻醉医师经验调节控制丙泊酚和瑞芬太尼的输注速度,丙泊酚的输注速度为75-100μg/kg/min,瑞芬太尼输注速度为150-200ng/kg/min,顺阿曲库铵是每隔30-45分钟给予2-3mg。分别观察记录T组和P组于诱导用药后气管插管前(T_1);气管插管时(T_2);气管插管后切皮时(T_3);开始进腹或进腔镜时(T_4);腹部探查游离或腔镜游离时(T_5);脏器切除时(T_6);拔管时(T_7)等七个时段的心率(HR)、血压(SBP、DBP)、体动情况、肌松满意程度,麻醉药用量等。此外,还观察苏醒期间的苏醒时间、苏醒的完全程度、苏醒期间的并发症等。以上几方面的数字技术最终通过麻醉信息系统进行整合分析记录。结果:T_4-T_7时,心率、血压T组与P组比较差异有统计学意义(P<0.05);T组术中无体动,P组有6例出现体动(P<0.05);T组肌松满意程度较好,TOF值<0.1,P组有7例出现短暂肌松不良(P<0.05);T组麻醉药和肌松药用量均更少,术后苏醒和肌松恢复更快,术后躁动发生率更低(P<0.05)。结论:高龄患者术中应用TCI麻醉,配合肌松闭环给药、从I监测调控、麻醉信息系统整合等具有很大优势,使高龄患者的麻醉过程更加平稳、苏醒质量更优、可控性和精确性更强、安全性更高。Objective： Discusses the digital technology in elderly patients with TCI anesthesia application value. Methods Do elective abdominal surgery, ASA II-III grade 60 cases of elderly patients, randomly divided into two groups （n=30）： TCI anesthesia monitoring group （hereinafter referred to as the ＂group T＂ and the control group（hereinafter referred to as the ＂P group＂）. Anesthesia was induced by both the fentanyl 3.3 p~ g/kg, midazolam 0.05mg/kg etomidate 0.3mg/kg, cis atracuriura 0.15mg/kg, T group after intubation anesthesia was maintained plasma target-controlled TCI, Intraoperative AAI value adjustment of propofol and remifentanil TCI plasma concentrations and closed-loop application of muscle relaxants monitoring feedback instruraent given muscle relaxants. Propofol target plasma concentration of 2.3-2.8 bt g/ml, remifentanil target plasma concentration of3.6-4.8ng/mlm, CIS-Atracurium is a closed-loop medication; group p only according to blood pressure, pulse and Anesthesiologists expe：dence controlled infusion of propofol and remifentanil speed, the propofol infusion rate 75-100 p. g/kg/min, remifentanil infusion raLe of 150 to 200ng/kg/min, CIS-Atracurium is every 30-45 minutes 2-3mg. Were observed in the log T and P groups after the induction of medication before tracheal intubation （T1）; tracheal intubation （T2）; After tracheal intubation cut skin （T3）; into the abdomen or into the endoscopic （T4）; abdominal exploration free or endoscooic free （T5）; organ resection （T6）; extubation （T7） and seven--time heart rate （HR）, blood pressure （SBP and DBP）, body movement, muscle relaxantssatisfaction, anesthetic dosage, and so on; In addition, still observe during waking the resurgence of the time, awakening degree, during waking completely complication. Aspects of digital technology eventual adoption of anesthesia information system to integrate the analysis of records. Results： T4-T7, heart rate, blood pressure in group T and P group, the difference was

关 键 词：数字化技术高龄患者手术TCI麻醉 

分 类 号：R614[医药卫生—麻醉学]