摘要
目的 以脑电双频指数 (BIS)作为麻醉镇静深度的监测手段 ,比较泵输注与手控输注在胃镜检查中的麻醉效果 ,探讨泵输注异丙酚行静脉麻醉的安全有效剂量。方法 美国麻醉医师学会建议的术前病人综合状况评级Ⅰ～Ⅱ级、行择期全麻胃镜检查病人 4 8例 ,均分为泵输注 (T)组和手控输注(M )组。两组均先静脉注射芬太尼 1μg/kg体重。T组异丙酚血药浓度从 1μg/ml开始 ,以 0 .5 μg/ml递增 ,待病人BIS值低于 6 0后置入胃镜 ,镜检过程中血药浓度维持于 2～ 3μg/ml。M组异丙酚以 4 g/h速度诱导 ,镜检过程中异丙酚 4～ 6mg·h-1·kg-1维持麻醉。镜检时以BIS 4 0～ 6 0之间来反馈调节麻醉深度。两组均于活检完成后停止输注。计算患者从麻醉诱导至镜检开始的时间 (T1)、镜检持续时间(T2 )、睁眼时间 (T3)和检查室内总滞留时间 (即定向力恢复并出院 ,T4 ) ;以及麻醉诱导用量 (P1)、总用药量 (P2 )和平均输注速率 (V)。结果 2组间T1差异有显著性 (P =0 .0 4 8) ,T2、T3、T4差异无显著性。M组P1和P2均高于T组 ,差异有显著性 (P <0 .0 1)。 2组间V差异无显著性 (P =0 .0 96 )。 2组患者在镜检开始和睁眼时的BIS值基本相近 (T和M分别为 4 7.6 3± 6 .2 3和 4 7.6 7± 10 .78;76 .88± 7.0 8和78.2 1± 5 .34)。T组开始?
Objective To compare the effect of target-controlled infusion (TCI) and manual controlled infusion (MCI) of propofol in out-patients undergoing gastroscopy with the sedative depth monitoring by bispectral index (BIS).Methods Forty-eight patients with physical status Ⅰ-Ⅱ scheduled for an elective gastroscopy under general anesthesia were enrolled in this study. All patients were randomly divided into two groups, group T (n=24) and group M (n=24). Before induction, all patients were received a single dose of fentanyl (1 μg/kg) intravenously. With the monitoring of BIS, the gastroscope was inserted in by the time of BIS value less than 60. Patients in group T received a propofol infusion with the initial plasma concentration of 1 μg/ml and then the dose was titrated upward by 0.5 μg/ml each time till the BIS values was less than 60 and then propofol was maintained at a concentration of 2-3 μg/ml. In the group M, propofol was infused at a rate of 4 g/h until the BIS was less than 60 and then propofol was administrated at a rate of 4-6 mg·h -1·kg -1. During the period of gastroscopy, the sedation depth was maintained by BIS value of 40 to 60. The infusion was stopped by the end of biopsy in both groups. The time from induction to put in the endoscopy, the examination maintenance and the duration of anesthesia, the induction and total amounts of propofol infused were recorded and the average infusion rate was calculated. Results The induction time was significantly shorter in group T than in group M. The duration of examination, time from the induction to opening the eyes and time from induction to the orientation were not significantly different between two groups. Propofol consumption for induction and maintenance was much higher in group M than in group T. The average infusion rate was not significantly different in both groups. The BIS values were almost same at the beginning of gastroscopy and at opening the eyes. The plasma concentration and effect-site concentration were (4.25 ±0.94) μg/ml an
出处
《中华消化杂志》
CAS
CSCD
北大核心
2004年第9期530-532,共3页
Chinese Journal of Digestion
