靶控输注和恒速输注丙泊酚在小儿麻醉中的比较
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Comparison of target-controlled infusion and manual infusion for propofol anaesthesia in children
背景与目的：小儿全凭静脉持续泵注丙泊酚的一项重要考证指标就是延长苏醒时间。由于靶控输注不需要人为计算输注速度，应用靶控输注能更好的满足临床需求，减少使用剂量和缩短苏醒时间。
1
方法：招募ASA分级I级，年龄1到12岁的儿童，随机分为靶控输注组和恒速输注组。靶控输注组持续靶控输注丙泊酚，恒速输注组以2.5mg/kg为负荷剂量，随后以15、13、11、9mg/kg/h的速度输注。术中麻醉医师调整丙泊酚的剂量使BIS值保持在40到60之间。
结果：74个儿童完成了研究。靶控输注组和恒速输注组的小儿停止丙泊酚输注后拔管时间分别是15.1（5.1）和16.2（6.1）分钟。靶控输注组和恒速输注的丙泊酚平均输注速度为16.7mg/kg/h（标准差为4.2）和14.6mg/kg/h（标准差为3.1）.靶控输注组的BIS值大于60的时间百分比显著的低于恒速输注组[10.2% (18.4%) vs 23.2% (26.3%), P¼0.016]。
结论：对比恒速输注，使用靶控输注可增大丙泊酚剂量，但是不会延长小儿苏醒时间，这与BIS值在正常范围内所占的时间比有关，这也可能也是一个在麻醉或镇静期间较为简单的丙泊酚用药滴定法。
Mu J, Jiang T, Xu X B, et al.
Comparison of target-controlled infusion and manual infusion for propofol anaesthesia in children ☆[J].
British Journal of Anaesthesia, 2018, 120(5):1049.
BACKGROUND: One major criticism of prolonged propofol-based total i.v. anaesthesia (TIVA) in children is the prolonged recovery time. As target-controlled infusion (TCI) obviates the need to manually calculate the infusion rate, the use of TCI may better match clinical requirements, reduce propofol dose, and shorten recovery time.
METHODS: Children of ASA grade 1, aged 1e12 yr, were recruited and randomly assigned to TCI or manual infusion.Children in the TCI group had propofol delivered by TCI. Children for manual infusion had a loading dose of 2.5 mg kg1 with subsequent infusion rates of 15, 13, 11, 10, and 9 mg/kg/h. Attending anaesthesiologists adjusted the propofol dosage to keep the Bispectral Index. (BIS) between 40 and 60.
RESULTS:Seventy-four children completed the study. The time taken to extubate the trachea after cessation of propofol was 15.1 (5.5) and 16.2 (6.1) min for children who had TCI and manual infusion, respectively (P?.42). The mean propofol infusion rate was 16.7 [standard deviation (SD) 4.2] mg kg1 h1 in the TCI group and 14.6 (3.1) mg kg1 h1 in the manual infusion group (P?.036). The percentage of time when BIS was >60 was significantly lower in the TCI than the manual infusion group [10.2% (18.4%) vs 23.2% (26.3%), P?.016].
CONCLUSIONS:Use of TCI led to higher propofol doses but not prolonged recovery time in children compared with manual infusion. It was associated with a greater percentage of time when the BIS was in the desired range and it may be an easier method for titration of propofol administration during anaesthesia or sedation.
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