目的：探讨脑电双频指数指导下丙泊酚闭环靶控输注麻醉对行经口腔前庭入路机器人辅助甲状腺切除术患者的临床疗 效。方法：选取 2020 年 6 月—2023 年 6 月空军军医大学第二附属医院 120 例行经口腔前庭入路机器人辅助甲状腺切除术的 患者作为研究对象，按照随机数表法将所有患者分为研究组（基于脑电双频指数指导下丙泊酚闭环靶控输注麻醉，n=60）和 对照组（丙泊酚开环输注麻醉，n=60）。比较两组患者围手术期麻醉相关指标、血流动力学指标、血清炎症指标、认知功能、 不良反应发生情况。结果：两组麻醉维持时间比较，差异无统计学意义（P>0.05）。相较于对照组，研究组术后自主呼吸恢 复时间、拔管时间、苏醒时间更短，丙泊酚用量、术后 24 h 视觉模拟评分法（VAS）评分更低（P<0.05）。重复测量显示， 比较两组 HR 时点 / 交互效应、平均动脉压（MAP）组间 / 交互效应，差异有统计学意义（P<0.05）。相较于诱导前，两组 插管时 HR、MAP 均降低，术毕即刻 MAP 降低（P<0.05），且相较于对照组，研究组插管时 HR、MAP 及术毕即刻 MAP 更 高、HR 更低（P<0.05）。重复测量显示，两组 CRP、IL-6 时点、组间、交互效应比较，差异有统计学意义（P<0.05）。 相较于诱导前，术毕即刻、术后 6 h、术后 24 h 两组 CRP、IL-6 均升高（P<0.05）。相较于对照组，研究组术后 6 h、术后 24 h CRP 更低，术毕即刻、术后 6 h、术后 24 h IL-6 更低（P<0.05）。重复测量显示，比较两组简易智力状态检查量表（MMSE） 评分组间效应，差异有统计学意义（P<0.05）。相较于诱导前，术后 1 d 两组 MMSE 评分均降低（P<0.05），且相较于对照组， 研究组术后 1 d、术后 3 d MMSE 评分更高（P<0.05）。相较于对照组，研究组不良反应总发生率更低（P<0.05）。结论：基 于脑电双频指数指导的丙泊酚闭环靶控输注麻醉用于经口腔前庭入路机器人辅助甲状腺切除术的麻醉效果良好，可有效稳定 血流动力学指标，缓解炎症反应，减轻认知功能损伤，减少不良反应发生率。

Objective: To explore the effectiveness of closed-loop controlled propofol anesthesia using bispectral index in patients who underwent transoral robot-assisted thyroidectomy vestibular approach (TORTVA). Methods: 120 patients who underwent TORTVA from June 2020 to June 2023 in the Second Affiliated Hospital of Air Force Military Medical University were selected, and they were divided into the study group (n=60, closed-loop controlled propofol anesthesia using bispectral index) and the control group (n=60, open-loop controlled infusion of propofol) using a random number table. The perioperative anaesthesia-related indexes, hemodynamic indexes, serum inflammation indexes, cognitive function, and adverse reactions were compared between the two groups of patients. Results: There was no significant difference in the anesthesia time between the two groups of patients (P>0.05). Compared with the control group, the study group had shorter postoperative spontaneous respiratory recovery time, extubation time and awakening time, but lower propofol dosage and 24 h postoperative VAS score (P<0.05). Repeated measures showed statistically significant differences in HR timepoint/interaction effect and MAP intergroup/interaction effect between the two groups of patients (P<0.05). Compared with that before induction, HR and MAP were decreased at intubation, and MAP was decreased immediately at the end of surgery in the two groups (P<0.05). Compared with the control group, the study group had higher HR and MAP at intubation, higher MAP and lower HR at immediate point after surgery (P<0.05). Repeated measurements showed statistically significant differences in timepoint, intergroup, and interaction effect of CRP and IL-6 between the two groups of patients (P<0.05). Compared with that before induction, levels of CRP and IL-6 were both increased in the two groups at immediate point after surgery, 6 h and 24 h after surgery (P<0.05). Compared with the control group, the CRP level of patients in the study group was lower at 6 h and 24 h after surgery, and IL-6 level was lower at the immediate point after surgery, 6 h and 24 h after surgery (P<0.05). Repeated measurements showed that the difference in the intergroup effect of MMSE scores between the two groups was statistically significant (P<0.05). Compared with that before induction, MMSE scores were both decreased in the two groups 1 d after surgery (P<0.05), and they were higher in the study group at 1 d and 3 d after surgery (P<0.05). The total incidence of adverse reactions was lower in the study group than that in the control group (P<0.05). Conclusion: Closed-loop control of propofol anesthesia using bispectral index in patients undergoing transoral robot-assisted thyroidectomy vestibular approach has a better anaesthesia effect, which can effectively stabilize hemodynamic indexes, alleviate inflammatory reactions, reduce cognitive impairment, and lower the incidence of adverse reactions.

基金项目：国家自然科学基金（81801391） 

Foundation Item: National Natural Science Foundation of China(81801391) 

引用格式：李伟，汪鸿，刘伟娜，等 . 脑电双频指数指导下丙泊酚闭环靶控输注麻醉在经口腔前庭入路机器人辅助甲状腺切除术中的应用 [J].  机器人外科学杂志（中英文），2025，6（2）：239-244. 

Citation: LI W, WANG H, LIU W N, et al. Closed-loop control of propofol anesthesia using bispectral index in patients undergoing transoral  robot-assisted thyroidectomy vestibular approach[J]. Chinese Journal of Robotic Surgery, 2025, 6(2): 239-244. 

通讯作者（Corresponding Author）：牛晶（NIU Jing），Email：15202960507@163.com

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