| Objective: To evaluate the accuracy and applicability of sufentanil multi-target target-controlled infusion in laparoscopic surgery,and to provide reference for the clinical application of sufentanil multi-target target-controlled infusion in laparoscopic surgery.Methods: This study is a prospective randomized controlled clinical trial.Patients who underwent elective laparoscopic radical resection of gastrointestinal tumors from January 2021 to June 2021 were selected.Sixty-six patients who met the inclusion criteria were randomly assigned to the study group or the control group.The research group was the sufentanil multi-target target-controlled infusion group.During the operation,the concentration of sufentanil effect chamber was adjusted according to the size of the surgical stimulus.After the establishment of pneumoperitoneum,the target concentration of sufentanil in effect chamber was adjusted to 0.40,0.25,0.50,0.30,0.25ng/ml at the beginning of the operation and when the pneumoperitoneum was finished and the abdomen was closed,and the target-controlled infusion was stopped after the operation;the control group For the sufentanil single-target target-controlled infusion group,the concentration of sufentanil in the effect chamber was adjusted to 0.40 ng/ml before induction to the end of the operation,and the target-controlled infusion was stopped after the operation.The two groups of patients received closed-loop target-controlled infusion of propofol during the operation,and the Bispectral index(BIS)ranged from 40 to 60.The main observation index of the study was the plasma drug concentration of sufentanil.The group took blood samples 5 minutes after the target concentration of sufentanil was adjusted and reached the target concentration and at the time of extubation;and measured by ultra-high performance liquid chromatography-mass spectrometry.Secondary outcome measures included circulatory indexes and recovery time before anesthesia induction(T0),at the time of tracheal intubation(T1),at the beginning of surgery(T2),at the time of auxiliary small incision(T3),and at the end of surgery(T4),intraoperative input and output,target-controlled infusion duration and dosage of propofol.Results: Thirty-two patients in the study group and 34 patients in the control group were included in the final statistical analysis.1.General information: There was no statistical difference in age,sex composition ratio,body mass index(BMI),and American Society of Anesthesiologist(ASA)classification between the two groups.2.Surgical conditions: There was no significant difference in intraoperative blood loss,urine volume,intraoperative crystalloid input,intraoperative colloid input,intraoperative total input and total output between the two groups.There were no significant differences in mean arterial pressure(MAP)and heart rate(HR)at T0,T1,T2,T3,and T4 between the two groups.Comparing the MAP at each time point of the two groups with the time point T0,the MAP at the time point T1 in the two groups increased,and the MAP at the other time points T2,T3,and T4 showed a downward trend,but the differences were not statistically significant(P> 0.05).The HR at each time point in the two groups was compared with the T0 time point.Compared with the T0 time point,the HR at the T1 time point in the two groups increased,and the HR at the other T2,T3,and T4 time points showed a downward trend.The difference was statistically significant(P<0.05),but the fluctuations were all within the normal range.3.Measured plasma drug concentration of sufentanil: There was no statistical difference between the measured plasma drug concentration of sufentanil and the expected plasma drug concentration of sufentanil at each time point between the two groups(P>0.05).The actual blood drug concentration of the group using target-controlled infusion can reach the target target-controlled concentration.4.Evaluation of the accuracy of target-controlled infusion of sufentanil: the deviation of the multi-target group and the single-target group was 4% and-2.5%,respectively,the accuracy was 20% and 15%,and the swing was 19% and 15%,respectively.%.The accuracy of the two groups at each time point,the deviation of the multi-target group and the single-target group at T1 was 8.75%,8.75%,the accuracy was16.25%,12.5%,and the swing was 12.25%,16.25%;T2 The deviations between the multi-target group and the single-target group were 17% and5%,the accuracy was 22%,17.5%,and the swing degrees were 18% and17.5%,respectively;at T3,the deviation between the multi-target group and the single-target group was The degrees were 1.67% and 0,respectively,the accuracy was 15%,13.75%,and the swing degrees were14% and 13.75%,respectively;at T4,the deviations between the multi-target group and the single-target group were 4% and 12.75%,respectively.They are 22% and 16.25% respectively,and the swing degrees are 26% and 8.75% respectively.The accuracy of target-controlled infusion of sufentanil in the two groups was within the acceptable range for clinical application,and the accuracy of target-controlled infusion of sufentanil at each time point in the two groups was within the acceptable range for clinical application.(Internationally,it is generally considered that the degree of |deviation|<20%,and the degree of accuracy and swing <30% is within the clinically acceptable range).5.Comparison of the performance error(PE)at each time point between the two groups of patients: There is no difference in the performance error of sufentanil plasma drug concentration at each time point between the sufentanil multi-target target concentration model and the single target target concentration model.Statistical significance(P>0.05).Comparing the execution error of sufentanil plasma drug concentration in the two groups of patients,there was no statistical difference between the study group at each time point(P>0.05).The comparison of the execution error of sufentanil plasma drug concentration at T1,T2 and T3 time points was statistically significant(P<0.05).6.Recovery time and plasma concentration of sufentanil during extubation: the recovery time of the patients in the study group was18±10min,and the recovery time of the patients in the control group was25±18min.The recovery time of the patients in the study group was shorter than that of the patients in the control group,and the difference was statistically significant academic significance(P=0.012).The plasma drug concentration of sufentanil in the study group was0.1833±0.04130ng/ml when the patients were extubated,and the plasma drug concentration of sufentanil in the control group was 0.2048±0.08004 when the patients were extubated.The concentrations were not statistically different(p=0.181).Conclusion: Through this study,we verified the accuracy and applicability of the sufentanil multi-target target-controlled infusion model.It is not significantly different from the predictable performance of the single target target-controlled infusion model,and the prediction capabilities of the two models are not significantly different.The stability of the sufentanil target TCI increases over time,and the measured concentration is 4% higher than the expected concentration.The application of multi-target target-controlled infusion model in laparoscopic surgery wake up faster,providing a reference for precision regulation of the sufentanil target-controlled infusion during laparoscopic surgery. |
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