腹部手术老年患者BIS指导下异丙酚闭环与开环靶控输注麻醉费效的比较  

Cost-effectiveness of closed-loop versus open-loop infusion of propofol guided by bispectral index in elderly patients undergoing abdominal surgery

作　　者：雍芳芳[1] 贾慧群[1] 杜少杰[1] 王合梅[1] 李超[1] 杜伟[1] 朱康生[1] 

机构地区：[1]河北医科大学第四医院麻醉科,石家庄市050011

出　　处：《中华麻醉学杂志》2017年第7期852-855,共4页Chinese Journal of Anesthesiology

摘　　要：目的 比较腹部手术老年患者BIS指导下异丙酚闭环与开环靶控输注麻醉的费效.方法 择期全麻下行胃肠道肿瘤切除术患者60例,性别不限,年龄65- 75岁,体重指数18-25 kg/m^2,ASA分级Ⅱ级.采用随机数字表法,将其分为2组（n=30）：闭环靶控输注组（C组）和开环靶控输注组（O组）.C组行异丙酚闭环靶控输注,设定目标BIS值为45-55;O组根据BIS值调节血浆靶浓度（2.0- 3.5 μg/ml）,维持BIS值45- 55;2组均靶控输注瑞芬太尼,血浆靶浓度2-8 ng/ml.记录异丙酚和瑞芬太尼的总用量、BIS值目标范围维持时间比率、术中高血压和低血压的发生情况、苏醒时间、气管拔管时间、定向力恢复时间、术后下床活动时间、排气时间以及术后住院时间.记录术后3d内恶心呕吐和谵妄的发生情况,术后随后术中知晓发生情况.计算麻醉药物费用和麻醉总费用.结果 与O组比较,C组异丙酚总用量降低,瑞芬太尼总用量增多,BIS值目标范围维持时间比率升高,苏醒时间、气拔管时间和定向力恢复时间缩短,异丙酚费用和麻醉总费用降低（P〈0.05）,瑞芬太尼费用、术后谵妄和恶心呕吐发生率、术后下床活动时间、排气时间以及术后住院时间差异无统计学意义（P〉0.05）.2组均未见术中知晓发生.结论 与BIS指导下异丙酚开环靶控输注麻醉比较,其指导下闭环靶控输注麻醉是老年患者开腹手术较为经济有效的麻醉方法.Objective To compare the cost-effectiveness of closed-loop versus open-loop infusion of propofol guided by bispectral index （BIS） in elderly patients undergoing abdominal surgery.Methods Sixty American Society of Anesthesiologists physical status Ⅱ patients of either sex,aged 65-75 yr,with body mass index of 18 25 kg/m^2,undergoing elective open gastrointestinal tumor resection with general anesthesia,were allocated into closed-loop target-controlled infusion （TCI） group （group C） and open-loop TCI group （group O） using a random number table.Propofol was given using closed-loop TCI,and the target BIS value was set at 45-55 in group C.In group O,the target plasma concentration （2.0-3.5 μg/ml）of propofol was adjusted to maintain the BIS value at 45-55.Remifentanil was given by TCI with the target plasma concentration of 2-8 ng/ml in both groups.The total consumption of propofol and remifentanil,time rate of maintaining BIS value within the target range,development of intraoperative hypertension and hypotension,emergence time,tracheal extubation time,time for recovery of orientation,first ambulation time,time to first flatus and length of postoperative hospital stay were recorded.The development of nausea and vomiting and delirium within 3 days after operation and intraoperative awareness was recorded.The cost of anesthetics and total cost of anesthesia were calculated.Results Compared with group O,the total consumption of propofol was significantly decreased,the total consumption of remifentanil was increased,the time rate of maintaining BIS value within the target range was increased,the emergence time,tracheal extubation time and time for recovery of orientation were shortened,the cost of propofol and total cost of anesthesia were decreased （P〈0.05）,and no significant change was found in the cost of remifentanil,incidence of postoperative delirium and nausea and vomiting,first ambulation time,time to first flatus or length of postoperative hospital stay in group C （P〉0.05）.Intra

关 键 词：药物释放系统 二异丙酚 脑电描记术 费用效益分析 

分 类 号：R614[医药卫生—麻醉学]