标题：CONCERT-CL闭环靶控输注系统对腹腔镜胃肠手术患者术后胃肠功能及免疫功能的影响

      作者：王芳琪，雷林军，付茂璟，魏子钦，王晓敏，谢妍    上海市徐汇区中心医院麻醉科，上海 200031

      卷次： 2024年35卷5期

      【摘要】 目的 探讨CONCERT-CL闭环靶控输注系统在腹腔镜胃肠手术患者中的应用效果及对患者术后胃肠功能和免疫功能的影响。方法 选取2022年8月至2023年5月上海市徐汇区中心医院收治的80例腹腔镜胃肠手术患者作为研究对象，按随机数表法分为观察组和对照组各40例。两组患者均采用相同的麻醉方案，但观察组患者采用CONCERT-CL闭环靶控输注系统进行麻醉管理，而对照组患者则采用开放式麻醉维持。比较两组患者的围术期相关指标、胃肠功能和围术期白细胞分化抗原(CD) TT细胞数量和自然杀伤细胞(NK)细胞数量，同时比较两组患者术后不良反应发生情况。结果 观察组患者的手术时间、麻醉时间分别为(183.60±30.15) min、(206.69±10.54) min，对照组分别为(189.12±43.85) min、(211.65±16.83) min，差异均无统计学意义(P>0.05)；观察组患者术中丙泊酚用量和顺式阿曲库铵用量分别为(13.34±2.00) mg/kg、(0.26±0.09) mg/kg，明显低于对照组的(15.96±1.41) mg/kg、(0.35±0.11) mg/kg，拔管即刻警觉-镇静(OAA/S)评分和术中BIS时间为40~60的占比分别为(3.46±0.25)分、(82.60±4.22)%，明显高于对照组的(3.12±0.46)分、(64.02±3.65)%，差异均有统计学意义(P<0.05)；观察组和对照组患者的肠鸣音恢复[(22.60±4.52) h vs (30.57±6.84) h]、腹痛缓解[(26.88±4.11) h vs (30.17±2.94) h]、术后首次排气时间[(32.69±4.25) h vs (44.35±1.68) h]比较，观察组明显短于对照组，差异均有统计学意义(P<0.05)；术后12 h，观察组和对照组患者的CD4+TT数量[(35.69±1.54)% vs (32.01±6.21)%]、NK细胞数量[(20.36±2.41)% vs (18.73±2.65)%]比较，观察组明显高于对照组，CD8+TT数量[(27.01±1.79)% vs (29.28±3.87)%]比较，观察组明显低于对照组，差异均有统计学意义(P<0.05)；观察组患者的不良反应总发生率为 5.00%，略低于对照组的 10.00%，但差异无统计学意义(P>0.05)。结论 CONCERT-CL闭环靶控输注系统在腹腔镜胃肠手术患者中的应用能够降低术中麻醉维持药物用量，患者苏醒速度更快。同时还能够促进患者术后胃肠功能的恢复，并且对免疫功能起到一定改善作用。
      【关键词】 CONCERT-CL闭环靶控输注系统；腹腔镜胃肠手术；麻醉患者；胃肠功能；免疫功能
      【中图分类号】 R656.6 【文献标识码】 A 【文章编号】 1003—6350（2024）05—0641—05

Effect of CONCERT-CL closed loop target control infusion system on gastrointestinal function and immunefunction after laparoscopic gastrointestinal surgery.
WANG Fang-qi, LEI Lin-jun, FU Mao-jing, WEI Zi-qin, WANGXiao-min, XIE-Yan. Department of Anesthesiology Shanghai Xuhui District Central Hospital, Shanghai 200031, CHINA
【Abstract】 Objective To investigate the effect of CONCERT-CL closed loop target control infusion system onpostoperative gastrointestinal function and immune function in patients undergoing laparoscopic gastrointestinal surgery.Methods From August 2022 to May 2023, 80 patients with laparoscopic gastrointestinal surgery in Shanghai XuhuiDistrict Central Hospital were selected and divided into the observation group (40 cases) and the control group (40 cas-es) according to random number table method. The two groups were given the same anesthesia regimen, while the obser-vation group was administered anesthesia using the CONCERT-CL closed loop target control infusion system, and thecontrol group was maintained with open anesthesia. The perioperative relevant indexes, gastrointestinal function, thenumber of TT cells of cluster of differentiation (CD), and the number of natural killer cell (NK) cells were compared be-tween the two groups, and the occurrence of postoperative adverse reactions were compared between the two groups.Results There was no statistically significant difference in operation time and anesthesia time between the observationgroup and the control group: (183.60±30.15) min vs (189.12±43.85) min, (206.69±10.54) min vs (211.65±16.83) min (P>0.05). The intraoperative dosage of propofol and cis-atracurium in the observation group were (13.34±2.00) mg/kg and(0.26±0.09) mg/kg, significantly lower than (15.96±1.41) mg/kg and (0.35±0.11) mg/kg in the control group; the scoreof observer's assessment of alertness/sedation (OAA/S) and proportion of BIS time of 40-60 in the observation groupwere (3.46±0.25) points, (82.60±4.22)%, significantly higher than (3.12±0.46) min and (64.02±3.65)% in the controlgroup; the differences were statistically significant (P<0.05). Compared with that in the control group, the recovery ofbowel sound [(22.60±4.52) h vs (30.57±6.84) h], abdominal pain relief [(26.88±4.11) h vs (30.17±2.94) h], first postopera-tive exhaust time [(32.69±4.25) h vs (44.35±1.68) h] in the observation group was shorter, with statistically significantdifferences (P<0.05). At 12 h after operation, the number of CD4+TT [(35.69±1.54)% vs (32.01±6.21)%] and NK cells[(20.36±2.41)% vs (18.73±2.65)%] in the observation group was higher, and the number of CD8+TT [(27.01±1.79)% vs(29.28±3.87)%] was lower, with statistically significant differences (P<0.05). There was no statistically significant differ-ence in the total incidence of adverse reactions between the two groups (5.00% vs 10.00%, P>0.05). Conclusion Theapplication of CONCERT-CL closed loop target control infusion system in laparoscopic gastrointestinal surgery patientscan reduce the amount of intraoperative anesthesia maintenance drugs, and patients can recover faster. At the same time,it can also promote the recovery of gastrointestinal function and improve the immune function.
      【Key words】 CONCERT-CL closed loop target control infusion system; Laparoscopic gastrointestinal surgery;Anesthesia patients; Gastrointestinal function; Immune function