对控制机器人甲状腺癌根治术患者手术应激反应麻醉深度的探讨

doi:10.6040/j.issn.1671-7554.0.2021.1315

摘要/Abstract

摘要： 目的探讨丙泊酚闭环靶控输注麻醉方式有效控制经双腋窝-乳晕径路机器人辅助甲状腺癌根治术(BABA-RAT)所致应激反应的最适麻醉深度。方法选择BABA-RAT患者60例,按丙泊酚闭环靶控输注目标脑电双频指数(BIS)值随机分为高目标值组(BIS:55±5)和低目标值组(BIS:45±5,不含50),每组30例。记录诱导开始前(T₀)、术中1 h(T₁)、术毕即刻(T₂)、术后6 h(T₃)心率(HR)和平均动脉压(MAP)。测定T₀、T₂、T₃、T₄(术后24 h)血清白介素6(IL-6)和C反应蛋白(CRP)浓度。记录丙泊酚用量及不良事件发生率。结果低目标值组丙泊酚用量高于高目标值组,MAP和HR各时点组间变化差异无统计学意义(P>0.05);低目标值组T₃、T₄时点的血清IL-6和CRP浓度的升高幅度明显低于高目标值组(P<0.05);低目标值组术后24 h VAS疼痛评分低于高目标值组(P<0.05);两组均未出现术中低血压、术中体动和术后认知功能障碍等不良事件。结论应用丙泊酚闭环靶控输注方式维持麻醉深度在BIS值为45±5水平较55±5水平更有效地抑制BABA-RAT的手术应激反应和术后疼痛程度。

关键词: 双腋窝-乳晕径路, 机器人手术系统, 甲状腺切除术, 麻醉深度, 闭环靶控输注, 手术应激反应

Abstract: Objective To investigate the optimal anesthesia depth with closed-loop administration of propofol guided by bispectral index(BIS)monitor to effectively inhibit surgical stress response in patients undergoing robot-assisted radical thyroidectomy(RAT)via bilateral axillo-breast approach(BABA). Methods A total of 60 patients undergoing BABA-RAT were enrolled and randomly assigned to the high target BIS group(55±5, n=30)and low target BIS group(45±5, n=30). Heart rate(HR), mean arterial pressure(MAP)were measured at the time points of pre-induction of anesthesia(T₀), 1h after operation beginning(T₁), the end of operation(T₂)and 6 h after operation(T₃). Serum concentration of IL-6 and C-reaction protein(CRP)were measured at T₀, T₂, T₃ and T₄(24 h after operation). Propofol consumption and incidence of adverse events were recorded. Results Propofol consumption was higher in the low target BIS group than in high target BIS group. There were no significant differences in MAP and HR at all the time-points between the two groups(P>0.05). Ascensional range of IL-6 and CRP were significantly lower in low target BIS group at T₃ and T₄(P<0.05). VAS was lower in low target BIS group 24 h postoperatively(P<0.05). No adverse events such as hypotension, intraoperative awareness or postoperative cognitive dysfunction occurred. Conclusion Anesthesia depth maintained at BIS of 45±5 is more effective than 55±5 to restrain surgical stress response and postoperative pain.

Key words: Bilateral axillo-breast approach, Robot surgical system, Thyroidectomy, Anesthesia depth, Closed-loop target control infusion, Surgical stress response

中图分类号:

R614

匡风霞,赵晓虹,韩宝佳,高成杰. 对控制机器人甲状腺癌根治术患者手术应激反应麻醉深度的探讨[J]. 山东大学学报 (医学版), 2022, 60(5): 81-86.

KUANG Fengxia, ZHAO Xiaohong, HAN Baojia, GAO Chengjie. Optimal anesthesia depth with propofol closed-loop administration to effectively inhibit surgical stress response in patients undergoing robot-assisted radical thyroidectomy via bilateral axillo-breast approach[J]. Journal of Shandong University (Health Sciences), 2022, 60(5): 81-86.

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