| The study of optimize the Bispectral index(BIS) feedback propofol closed-loop target controlled infusion and achieve the fully automatically controlled, validates the feasibility, security, superiority of the closed-loop target controlled infusion in the gastrointestinal tumor operation under total intravenous anesthesia.One hundred and fifty patients who were intended to gastrointestinal tumor operation under total intravenous anesthesia ASA?-?,18~70 years old, were randomly separated into three groups: constant speed infusion group(CI group, n=50), open-loop target controlled group(OLTCI group,n=50) and closed-loop target controlled group(CLTCI group, n=50),In the CI group, the anesthetist was manual adjustment of infusion speed of propofol accorded to the patient's weight, the monitoring BIS and personal experience. In the OLTCI group, the anesthetist was set up the target controlled infusion of propofol firstly, then opened-loop target controlled infusion of propofol, using the manual adjustment of propofol target controlled concentration based on monitoring of BIS and experience. In the CLTCI group, the TCI system was automatic adjustment of target controlled concentration of propofol according to the monitoring BIS, BIS was maintained between 45 to 55. Anesthesia process was divided into two parts: anesthesia induction and anesthesia maintenance. Anesthesia induction of propofol target controlled start to 1 min after a successful endotracheal intubation. Anesthesia maintenance for endotracheal intubation success after 1 min to the end of target controlled infusion. Theentire process of anesthesia, we used CONCERT-CL to infusion propofol,set up BIS between 45 to 55. In anesthesia induction, CI group infused propofol by 2.5kg·mg-1 in five minutes. OLTCI group was set propofol TCI4.0?g·ml-1, CLTCI group was set BIS between 45 to 55,propofol TCI5.0?g·ml-1. When consciousness disappear or BIS down to 65, patients was received vecuronium 0.15mg·kg-1, three minutes after was intubation endotracheal when BIS under 60.In anesthesia maintenance, CI group and OLTCI group, the anesthetist was manual adjustment of infusion speed or target controlled concentration of propofol according to the monitoring BIS and anesthetist's experience. CLTCI group, the TCI was automatic adjustment of propofol according to the monitoring BIS,BIS was maintained 45 to 55. At the same time of infused propofol, targeted controlled infusion of remifentanil for analgesic in the operation, the anesthetist was manual adjustment of the target controlled concentration of remifentanil was 4~6ng·mg-1 accorded to hemodynamic indexes. During the surgery is no longer use other analgesic sedative drugs and inhalation anesthetics. Observed and recorded Mean arterial pressure(MAP), Heart rate(HR), bispectral index(BIS) at before anesthesia(T0), consciousness disappear(T1), achieve the BIS set range(T2), endotracheal intubation(T3),after endotracheal intubation 1 min(T4), before skin incision(T5), skin incision(T6), intraoperative exploration(T7), close peritoneum(T8), stop of target controlled infusion propofol 5min(T9), observed the full time of anesthesia(40<BIS<60) and regulating frequency of target controlled infusion pump, situation of anesthesia recover, follow-up studied of the incidence rate of postoperative complications in nausea and vomit, chill,intraopertive awareness.At the ten points adopted arterial blood from radial artery, pretreatment of plasma, compared Measured Concentration(Cm)and Predicted Concentration(Cp) of propofol in the three groups. The evaluation index inpcorporated the median performance error(MDPE),inaccuracy or the median absolute performance error(MDAPE) and the global score(GS).The experimental results was showed:(1)Compared MAP, HR in the same group: as against contrast with T0,the MAP of three groups were reduced at T1~T9(P<0.05), the HR of three groups were reduced at T1,T2, T5, T8 four times.(2)Compared MAP, HR in different groups: the three groups had a significantly difference of MAP than CLTCI group at T4, T5, T6,T7, T9(P<0.05), There was significantly difference of HR at T5 within three groups(P<0.05).(3)Compared BIS in the same group: as against contrast with T0,the BIS of three groups were reduced at T1~T9. In the CI group, BIS dropped low to 45 at T5, T8 points, in the OLTCI group, BIS dropped low to 45 at T5 point.(4)Compared BIS in different groups: a lower of BIS at T2,T3, T5, T8 were greater in C group and OLTCI group than CLTCI group(P<0.05).The BIS of T4, T6, T7 significantly increased in C group and OLTCI group than CLTCI group(P<0.05),CI group was a significantly lower than OLTCI group and CLTCI group at T5 point.CLTCI group was a significantly increased at T9 than OLTCI group(P<0.05).(5)The proportion of full time of anesthesia: there was significantly difference in adequate anesthesia time between C group, OLTCI group and CLTCI group.(6)There was no significantly difference of Cm and Cp in the three groups(P>0.05).The Cm of CLTCI group at T1~T5,T7~T9 was significantly difference in the three groups(P<0.05).(7)CLTCI group was apparently higher than C group and OLTCI group in regulating frequency of target controlled infusion pump(P<0.05).(8)There was shorter the opening eyes time, extubation time and orientation recovery time in three groups(P<0.05).(9)There was no significantly difference in the incidence rate of nausea and vomit, chill,between C group, OLTCI group and CLTCI group(P>0.05).(10) There was 2 cases judged intraopertive awareness in CI group and OLTCI group.(11) The MDPE, MEAPE and GS was in the scope of clinical allows(MDPE<15%,MDAPE<30%). There were significantly difference in MDPAE, GS in three groups(P<0.05).Then we can get the conclusion that BIS feedback propofol closed-loop target controlled infusion is better than open-loop target controlled infusion, CLTCI can achieve more stable in hemodynamic and BIS, maintenance the reasonable anesthesia depth, accelerate the recovery quality after surgical. So, it is safe and reliable in the gastrointestinal tumor operation. |
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