清醒浓度（MAC-awake）七氟醚对妇科全凭静脉麻醉患者丙泊酚半数有效血浆靶浓度及血流动力学的影响

发布时间：2018-01-07 18:37

  本文关键词：清醒浓度（MAC-awake）七氟醚对妇科全凭静脉麻醉患者丙泊酚半数有效血浆靶浓度及血流动力学的影响　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 靶控输注 脑电双频谱指数 清醒浓度七氟醚 序贯法

【摘要】：目的:对靶控输注丙泊酚、舒芬太尼全凭静脉麻醉的妇科手术患者,测定脑电双频谱指数50时的丙泊酚半数有效血浆靶浓度(Cp50),并观察清醒浓度(MAC-awake)七氟醚对该值及血流动力学的影响。方法:妇科择期行下腹部手术的患者,ASA分级Ⅰ-Ⅱ级,年龄18-65周岁,体重指数(BMI)18-32kg/m2。随机分为2组:实验组、吸入七氟醚组(S,17例)和全凭静脉组、对照组(P,16例)。麻醉诱导:两组患者均采用静脉快速诱导,靶控输注舒芬太尼(效应室浓度0.5ng/ml),静脉注射0.2mg/kg的依托咪酯脂肪乳,待患者睫毛反射消失后,静脉注射0.2mg/kg的顺-苯磺酸阿曲库铵。麻醉插管:麻醉诱导6min后,BIS值60,置入气管导管。麻醉维持:S组吸入七氟醚,维持呼末麻醉气体浓度0.33%(即清醒浓度(MAC-awake))。S组与P组均采用序贯法,靶控输注丙泊酚。靶控输注舒芬太尼,待舒芬太尼浓度降到0.2ng/ml时便以该靶浓度维持麻醉直至关腹。麻醉苏醒:关腹后实验组关七氟醚,两组均停止输注舒芬太尼并调整丙泊酚靶浓度维持BIS值50,缝皮前5分钟停止靶控输注丙泊酚。采集患者入室的基础值(T0)、切皮(T,)、开腹(T2)、开腹探查(T3……12)、关腹(Tn)、术毕(Tn-1),共15个时间点的心率(HR)、平均动脉压(MAP)、血氧饱和度(Sp02)、脑电双频谱指数(BIS值)及呼末二氧化碳浓度(EtCO2)。记录两组中每个患者的丙泊酚血浆靶浓度,利用统计学计算公式求丙泊酚的半数有效血浆靶浓度及其95%置信区间。术后24小时内床旁随访:术后恶心呕吐(PONV)及术中知晓的情况。结果:S组和P组最终纳入患者例数分别为17例和16例,维持BIS值50时丙泊酚的Cp50及95%CI分别为 1.61 μg/ml(95%CI 1.57-1.66 μg/ml)和2.17μg/ml(95%CI 2.07-2.29 μg/ml),S组比P组丙泊酚所需浓度低(P0.05),差异有统计学意义。结论:妇科下腹部手术脑电双频谱指数50时,吸入清醒MAC浓度七氟醚组与全凭静脉麻醉丙泊酚Cp50及95%CI分别为:1.61 μg/ml(95%CI 1.57-1.66 μg/ml)和2.17μg/ml(95%CI 2.07-2.29 μg/ml)。两种麻醉方法均能维持血流动力学平稳,差异无统计学意义(P0.05)。
[Abstract]:Objective: to target controlled infusion of propofol, sufentanil with total intravenous anesthesia for patients undergoing gynecological surgery, 50 propofol half effective target plasma concentration determination of bispectral index (Cp50), and concentration (MAC-awake) to observe the effect of sevoflurane on the value and hemodynamics. Methods: gynecological elective lower abdominal surgery patients with ASA grade I-II, age 18-65 years of age, body mass index (BMI) of 18-32kg/m2. were randomly divided into 2 groups: experimental group, sevoflurane group (S, n = 17) and total intravenous group, control group (P, n = 16). The induction of anesthesia: two groups of patients were treated with intravenous rapid induction. Target controlled infusion of sufentanil (effectcompartmentconcentration 0.5ng/ml), intravenous injection of 0.2mg/kg of etomidate fat emulsion for patients, eyelash reflex disappeared after intravenous injection of 0.2mg/kg CIS atracurium anesthesia intubation anesthesia. After 6min induction, the BIS value is 60, the tracheal catheter anesthesia: S. 缁勫惛鍏ヤ竷姘熼啔,缁存寔鍛兼湯楹婚唹姘斾綋娴撳害0.33%(鍗虫竻閱掓祿搴，

本文编号：1393774