丙泊酚闭环麻醉的临床应用
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摘要
丙泊酚闭环麻醉将靶控输注技术与监测麻醉深度的脑电双频指数有机结合,通过反馈机制维持设定的麻醉深度。目前丙泊酚闭环麻醉已应用于全身麻醉、镇静麻醉以及与其他麻醉方式相结合的联合麻醉。丙泊酚闭环麻醉不仅可用于身体条件较好的一般患者,也可用于老年、小儿、肥胖及重症患者,并能有效避免麻醉过深。丙泊酚闭环麻醉可以维持稳定的麻醉深度,避免麻醉过深或过浅,术后谵妄和认知功能障碍的发生率降低,但其总的给药量与是否使用闭环麻醉无相关性。各种因素对脑电双频指数的影响以及反馈的延迟导致了丙泊酚闭环麻醉的局限性。
The closed-loop anesthesia of propofol combines the target controlled infusion technique with bispectral index which monitors the depth of anesthesia,and maintains the depth of anesthesia through the feedback mechanism. At present,the closed-loop propofol anesthesia has been applied in general anesthesia,sedation anesthesia and combined anesthesia.The closed-loop anesthesia of propofol not only can be used in the general patients,but also can be used in the elderly,the children,the obese and the severe patients,which can effectively avoid the deep anesthesia. The closed-loop propofol anesthesia can maintain the depth of anesthesia,avoid deep or shallow anesthesia,and reduce the incidence of postoperative delirium and cognitive dysfunction. However,the total dose of propofol is not correlated with the use of closed-loop anesthesia. The effects of various factors on bispectral index and delayed feedback are the limitations of using closed-loop propofol anesthesia.
The closed-loop anesthesia of propofol combines the target controlled infusion technique with bispectral index which monitors the depth of anesthesia,and maintains the depth of anesthesia through the feedback mechanism. At present,the closed-loop propofol anesthesia has been applied in general anesthesia,sedation anesthesia and combined anesthesia.The closed-loop anesthesia of propofol not only can be used in the general patients,but also can be used in the elderly,the children,the obese and the severe patients,which can effectively avoid the deep anesthesia. The closed-loop propofol anesthesia can maintain the depth of anesthesia,avoid deep or shallow anesthesia,and reduce the incidence of postoperative delirium and cognitive dysfunction. However,the total dose of propofol is not correlated with the use of closed-loop anesthesia. The effects of various factors on bispectral index and delayed feedback are the limitations of using closed-loop propofol anesthesia.
引文
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[7]鹿曼曼,杨改生,李晓晶.丙泊酚全自动闭环靶控输注全静脉麻醉在胃肠道肿瘤手术中的应用[J].中国临床药理学杂志,2016,32(11):975-977.
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[10]Mahajan V,Samra T,Puri GD.Anaesthetic depth control using closed loop anaesthesia delivery system vs.target controlled infusion in patients with moderate to severe left ventricular systolic dysfunction[J].J Clin Anesth,2017,42:106-113.
[11]Zaouter C,Hemmerling TM,Lanchon R,et al.The feasibility of a completely automated totalⅣanesthesia drug delivery system for cardiac surgery[J].Anesth Analg,2016,123(4):885-893.
[12]Restoux A,Grassin-Delyle S,Liu N,et al.Pilot study of closedloop anaesthesia for liver transplantation[J].Br J Anaesth,2016,117(3):332-340.
[13]黄焕森,郑志远,高崇荣,等.丙泊酚闭环靶控输注全凭静脉麻醉在颅脑手术的应用[J].中华神经医学杂志,2006,5(6):623-625.
[14]曾涟,韦雄丽,阳丽云,等.BIS指导下丙泊酚闭环靶控输注在老年患者开腹手术中的应用[J].临床麻醉学杂志,2015,31(10):980-983.
[15]颜景佳,曾枝敏,孙加晓,等.精准化闭环靶控输注丙泊酚用于老年患者骨科手术麻醉的观察[J].中国微创外科杂志,2018,18(1):11-14.
[16]雍芳芳,贾慧群,杜少杰,等.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[J].中华麻醉学杂志,2017,37(7):852-855.
[17]Orliaguet GA,Benabbes Lambert F,Chazot T,et al.Feasibility of closed-loop titration of propofol and remifentanil guided by the bispectral monitor in pediatric and adolescent patients:A prospective randomized study[J].Anesthesiology,2015,122(4):759-767.
[18]Biswas I,Mathew PJ,Singh RS,et al.Evaluation of closed-loop anesthesia delivery for propofol anesthesia in pediatric cardiac surgery[J].Paediatr Anaesth,2013,23(12):1145-1152.
[19]郭键,李海英,刘晓华,等.异丙酚靶控输注用于肥胖人群的可行性研究[J].医学临床研究,2016,33(5):948-949.
[20]Liu N,Lory C,Assenzo V,et al.Feasibility of closed-loop coadministration of propofol and remifentanil guided by the bispectral index in obese patients:A prospective cohort comparison[J].Br J Anaesth,2015,114(4):605-614.
[21]Bataille A,Letourneulx JF,Charmeau A,et al.Impact of a prophylactic combination of dexamethasone-ondansetron on postoperative nausea and vomiting in obese adult patients undergoing laparoscopic sleeve gastrectomy during closed-loop propofol-remifentanil anaesthesia:A randomised double-blind placebo-controlled study[J].Eur J Anaesthesiol,2016,33(12):898-905.
[22]Le Guen M,Liu N,Tounou F,et al.Dexmedetomidine reduces propofol and remifentanil requirements during bispectral indexguided closed-loop anesthesia:A double-blind,placebo-controlled trial[J].Anesth Analg,2014,118(5):946-955.
[23]Liu N,Le Guen M,Boichut N,et al.Nitrous oxide does not produce a clinically important sparing effect during closed-loop delivered propofol-remifentanil anaesthesia guided by the bispectral index:A randomized multicentre study[J].Br J Anaesth,2014,112(5):842-851.
[24]王鹰,魏威,甄宇,等.七氟醚对丙泊酚闭环靶控效果的影响[J].国际麻醉学与复苏杂志,2017,38(2):106-109.
[25]嵇富海,李敏,梁雅芬,等.硬膜外阻滞辅以丙泊酚闭环靶控镇静[J].临床麻醉学杂志,2004,20(10):579-581.
[26]Zaouter C,Hemmerling TM,Mion S,et al.Feasibility of automated propofol sedation for transcatheter aortic valve implantation:A pilot study[J].Anesth Analg,2017,125(5):1505-1512.
[27]Chiang MH,Wu SC,You CH,et al.Target-controlled infusion vs.manually controlled infusion of propofol with alfentanil for bidirectional endoscopy:A randomized controlled trial[J].Endoscopy,2013,45(11):907-914.
[28]West N,Dumont GA,van Heusden K,et al.Robust closed-loop control of induction and maintenance of propofol anesthesia in children[J].Paediatr Anaesth,2013,23(8):712-719.
[29]Chen L,Wang M,Xiang H,et al.Prediction of effect-site concentration of sufentanil by dose-response target controlled infusion of sufentanil and propofol for analgesic and sedation maintenance in burn dressing changes[J].Burns,2014,40(3):455-459.
[30]Mei B,Zha H,Lu X,et al.Peripheral nerve block as a supplement to light or deep general anesthesia in elderly patients receiving total hip arthroplasty:A prospective randomized study[J].Clin J Pain,2017,33(12):1053-1059.
[31]Chan MT,Cheng BC,Lee TM,et al.BIS-guided Anesthesia Decreases Postoperative Delirium and Cognitive Decline[J].J Neurosurg Anesthesiol,2013,25(1):33-42.
[32]Cotoia A,Mirabella L,Beck R,et al.Effects of closed-loop intravenous anesthesia guided by the Bispectral index in adult patients on emergence delirium:A randomized controlled study[J].Minerva Anestesiol,2018,84(4):437-446.
[33]Bataille A,Guirimand A,Szekely B,et al.Does a hypnosis session reduce the required propofol dose during closed-loop anaesthesia induction:A randomised controlled trial[J].Eur J Anaesthesiol,2017,Epub ahead of print.
[34]Pasin L,Nardelli P,Pintaudi M,et al.Closed-loop delivery systems versus manually controlled administration of totalⅣanesthesia:A meta-analysis of randomized clinical trials[J].Anesth Analg,2017,124(2):456-464.
[35]Shiraishi T,Uchino H,Sagara T,et al.A comparison of frontal and occipital bispectral index values obtained during neurosurgical procedures[J].Anesth Analg,2004,98(6):1773-1775.
[36]Zanner R,Plige S,Kochs EF,et al.Time delay of electroencephalogram index calculation:Analysis of cerebral state bispectral and narcotrendindices using perioperatively recorded electroencephalographic signals[J].Br J Anaesth,2009,103(3):394-399.
[37]Barr G,Anderson RE,Owall A,et al.Effects on the bispectral index during medium-high dose fentanyl induction with or without propofol supplement[J].Acta Anaesthesiol Scand,2000,44(7):807-811.
[38]Reboso JA,Méndez JA,Reboso HJ,et al.Design and implementation of a closed-loop control system for infusion of propofol guided by bispectral index(BIS)[J].Acta Anaesthesiol Scand,2012,56(8):1032-1041.
[2]王萌,许幸,吴新民.脑电双频谱指数反馈调控异丙酚靶控输注静脉麻醉[J].中华麻醉学杂志,2002,22(6):339-343.
[3]张江超,续飞,郭向阳,等.脑电双频指数在麻醉中的应用[J].中国微创外科杂志,2016,16(7):661-664.
[4]Glass PS,Bloom M,Kearse L,et al.Bispectral analysis measures sedation and memory effects of propofol,midazolam,isoflurane,and alfentail in healthy volunteers[J].Anesthesiology,1997,86(4):836-847.
[5]张杰,钟声宏,毛振北.BIS监测对全静脉麻醉循环及丙泊酚用量的影响[J].当代医学,2014,20(2):69.
[6]王立金,李宗超,魏武.脑电双频指数监测在全凭静脉麻醉中的应用[J].中外医学研究,2014,12(11):55-56.
[7]鹿曼曼,杨改生,李晓晶.丙泊酚全自动闭环靶控输注全静脉麻醉在胃肠道肿瘤手术中的应用[J].中国临床药理学杂志,2016,32(11):975-977.
[8]Liu Y,Li M,Yang D,et al.Closed-loop control better than openloop control of profofol TCI guided by BIS:A randomized,controlled,multicenter clinical trial to evaluate the CONCERT-CL closed-loop system[J].PLo S One,2015,10(4):e0123862.
[9]Liu N,Chazot T,Hamada S,et al.Closed-loop coadministration of propofol and remifentanil guided by bispectral index:A randomized multicenter study[J].Anesth Analg,2011,112(3):546-557.
[10]Mahajan V,Samra T,Puri GD.Anaesthetic depth control using closed loop anaesthesia delivery system vs.target controlled infusion in patients with moderate to severe left ventricular systolic dysfunction[J].J Clin Anesth,2017,42:106-113.
[11]Zaouter C,Hemmerling TM,Lanchon R,et al.The feasibility of a completely automated totalⅣanesthesia drug delivery system for cardiac surgery[J].Anesth Analg,2016,123(4):885-893.
[12]Restoux A,Grassin-Delyle S,Liu N,et al.Pilot study of closedloop anaesthesia for liver transplantation[J].Br J Anaesth,2016,117(3):332-340.
[13]黄焕森,郑志远,高崇荣,等.丙泊酚闭环靶控输注全凭静脉麻醉在颅脑手术的应用[J].中华神经医学杂志,2006,5(6):623-625.
[14]曾涟,韦雄丽,阳丽云,等.BIS指导下丙泊酚闭环靶控输注在老年患者开腹手术中的应用[J].临床麻醉学杂志,2015,31(10):980-983.
[15]颜景佳,曾枝敏,孙加晓,等.精准化闭环靶控输注丙泊酚用于老年患者骨科手术麻醉的观察[J].中国微创外科杂志,2018,18(1):11-14.
[16]雍芳芳,贾慧群,杜少杰,等.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[J].中华麻醉学杂志,2017,37(7):852-855.
[17]Orliaguet GA,Benabbes Lambert F,Chazot T,et al.Feasibility of closed-loop titration of propofol and remifentanil guided by the bispectral monitor in pediatric and adolescent patients:A prospective randomized study[J].Anesthesiology,2015,122(4):759-767.
[18]Biswas I,Mathew PJ,Singh RS,et al.Evaluation of closed-loop anesthesia delivery for propofol anesthesia in pediatric cardiac surgery[J].Paediatr Anaesth,2013,23(12):1145-1152.
[19]郭键,李海英,刘晓华,等.异丙酚靶控输注用于肥胖人群的可行性研究[J].医学临床研究,2016,33(5):948-949.
[20]Liu N,Lory C,Assenzo V,et al.Feasibility of closed-loop coadministration of propofol and remifentanil guided by the bispectral index in obese patients:A prospective cohort comparison[J].Br J Anaesth,2015,114(4):605-614.
[21]Bataille A,Letourneulx JF,Charmeau A,et al.Impact of a prophylactic combination of dexamethasone-ondansetron on postoperative nausea and vomiting in obese adult patients undergoing laparoscopic sleeve gastrectomy during closed-loop propofol-remifentanil anaesthesia:A randomised double-blind placebo-controlled study[J].Eur J Anaesthesiol,2016,33(12):898-905.
[22]Le Guen M,Liu N,Tounou F,et al.Dexmedetomidine reduces propofol and remifentanil requirements during bispectral indexguided closed-loop anesthesia:A double-blind,placebo-controlled trial[J].Anesth Analg,2014,118(5):946-955.
[23]Liu N,Le Guen M,Boichut N,et al.Nitrous oxide does not produce a clinically important sparing effect during closed-loop delivered propofol-remifentanil anaesthesia guided by the bispectral index:A randomized multicentre study[J].Br J Anaesth,2014,112(5):842-851.
[24]王鹰,魏威,甄宇,等.七氟醚对丙泊酚闭环靶控效果的影响[J].国际麻醉学与复苏杂志,2017,38(2):106-109.
[25]嵇富海,李敏,梁雅芬,等.硬膜外阻滞辅以丙泊酚闭环靶控镇静[J].临床麻醉学杂志,2004,20(10):579-581.
[26]Zaouter C,Hemmerling TM,Mion S,et al.Feasibility of automated propofol sedation for transcatheter aortic valve implantation:A pilot study[J].Anesth Analg,2017,125(5):1505-1512.
[27]Chiang MH,Wu SC,You CH,et al.Target-controlled infusion vs.manually controlled infusion of propofol with alfentanil for bidirectional endoscopy:A randomized controlled trial[J].Endoscopy,2013,45(11):907-914.
[28]West N,Dumont GA,van Heusden K,et al.Robust closed-loop control of induction and maintenance of propofol anesthesia in children[J].Paediatr Anaesth,2013,23(8):712-719.
[29]Chen L,Wang M,Xiang H,et al.Prediction of effect-site concentration of sufentanil by dose-response target controlled infusion of sufentanil and propofol for analgesic and sedation maintenance in burn dressing changes[J].Burns,2014,40(3):455-459.
[30]Mei B,Zha H,Lu X,et al.Peripheral nerve block as a supplement to light or deep general anesthesia in elderly patients receiving total hip arthroplasty:A prospective randomized study[J].Clin J Pain,2017,33(12):1053-1059.
[31]Chan MT,Cheng BC,Lee TM,et al.BIS-guided Anesthesia Decreases Postoperative Delirium and Cognitive Decline[J].J Neurosurg Anesthesiol,2013,25(1):33-42.
[32]Cotoia A,Mirabella L,Beck R,et al.Effects of closed-loop intravenous anesthesia guided by the Bispectral index in adult patients on emergence delirium:A randomized controlled study[J].Minerva Anestesiol,2018,84(4):437-446.
[33]Bataille A,Guirimand A,Szekely B,et al.Does a hypnosis session reduce the required propofol dose during closed-loop anaesthesia induction:A randomised controlled trial[J].Eur J Anaesthesiol,2017,Epub ahead of print.
[34]Pasin L,Nardelli P,Pintaudi M,et al.Closed-loop delivery systems versus manually controlled administration of totalⅣanesthesia:A meta-analysis of randomized clinical trials[J].Anesth Analg,2017,124(2):456-464.
[35]Shiraishi T,Uchino H,Sagara T,et al.A comparison of frontal and occipital bispectral index values obtained during neurosurgical procedures[J].Anesth Analg,2004,98(6):1773-1775.
[36]Zanner R,Plige S,Kochs EF,et al.Time delay of electroencephalogram index calculation:Analysis of cerebral state bispectral and narcotrendindices using perioperatively recorded electroencephalographic signals[J].Br J Anaesth,2009,103(3):394-399.
[37]Barr G,Anderson RE,Owall A,et al.Effects on the bispectral index during medium-high dose fentanyl induction with or without propofol supplement[J].Acta Anaesthesiol Scand,2000,44(7):807-811.
[38]Reboso JA,Méndez JA,Reboso HJ,et al.Design and implementation of a closed-loop control system for infusion of propofol guided by bispectral index(BIS)[J].Acta Anaesthesiol Scand,2012,56(8):1032-1041.