酗酒对丙泊酚静脉麻醉的影响及血药浓度分析

发布时间：2018-03-03 18:27

本文选题：丙泊酚　切入点：酗酒　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:丙泊酚是目前临床最常用的静脉麻醉药之一,与非饮酒者相比,酗酒会增加丙泊酚诱导剂量,要达到相同的麻醉深度,酗酒者所需的丙泊酚药量相对较高。发生该现象的机制仍不明确,本文从药物代谢角度,系统地比较了酗酒者与非酗酒组丙泊酚血药浓度的差异,初步探讨了该现象发生的原因,以期为临床工作提供参考。方法:选取24名普外科择期手术患者,采用酒精使用障碍筛查量表(AUDIT)将手术患者分为酗酒组和对照组,常规静脉麻醉诱导,采用靶控输注方式给予丙泊酚,比较酗酒组和对照组患者接受丙泊酚静脉麻醉过程中术中血压波动事件发生率以及术后苏醒时间的差异;建立高效液相色谱-荧光法以测定丙泊酚的血药浓度,考察两组患者术中及术后丙泊酚实际血药浓度,比较其代谢差异。结果:本实验建立了利用高效液相色谱-荧光法测定丙泊酚血药浓度的方法,该方法灵敏度、精密度较高,回收率良好,最低定量限为0.01μg/ml,在0.1-5μg/mL浓度范围内线性良好,且不会受到其他常用药物的干扰,能够满足本实验测定需求,是一种快速、准确的药物定量分析方法。本实验记录并分析了酗酒组与对照组术中发生高血压和低血压事件的频次,发现酗酒组发生高血压事件的频次略高于对照组,但差异并不显著(P=0.096),而发生低血压事件的频次显著低于对照组(P0.05)。两组患者稳态血药浓度之间无明显差异,而停止输注丙泊酚后,两组患者的血药浓度存在一定差异,酗酒组血药浓度略高于对照组(P=0.050)。这种差异提示了两组患者之间代谢速率的不同,酗酒组患者体内的药物消除速率略低于对照组患者。结论:酗酒对丙泊酚麻醉效果有一定得影响,酗酒者可能对丙泊酚的麻醉效果有一定的耐受,但饮酒对丙泊酚麻醉效果的影响并非或很少程度上是通过影响丙泊酚代谢引起的,丙泊酚的血药浓度并非是引起饮酒者与非饮酒者麻醉效果差异的关键因素。
[Abstract]:Objective: propofol is one of the most commonly used intravenous anesthetics in clinic at present. Compared with non-drinkers, drinking alcohol will increase the induced dose of propofol and reach the same depth of anesthesia. The mechanism of propofol in alcoholics is still unclear. From the point of drug metabolism, the differences of plasma propofol concentrations between alcoholics and non-alcoholics were systematically compared. The causes of this phenomenon were preliminarily discussed in order to provide reference for clinical work. Methods: 24 patients undergoing elective surgery in general surgery were divided into alcoholism group and control group by alcohol use disorder screening scale (AUDITT). Conventional intravenous anesthesia was induced by target-controlled infusion of propofol. The incidence of intraoperative blood pressure fluctuation and postoperative recovery time were compared between the alcoholic group and the control group during the course of intravenous anesthesia with propofol. A high performance liquid chromatography-fluorescence method was established to determine the plasma concentration of propofol, and to investigate the actual concentration of propofol during and after operation. Results: a high performance liquid chromatography-fluorescence method was established for the determination of propofol concentration in blood. The minimum quantitative limit is 0.01 渭 g / ml. The linear range of 0.1-5 渭 g / mL is good, and it is not interfered by other commonly used drugs. This study recorded and analyzed the frequency of hypertension and hypotension events in the alcoholism group and the control group, and found that the frequency of hypertension events in the alcoholic group was slightly higher than that in the control group. However, the frequency of hypotension events was significantly lower than that of the control group (P 0.05). There was no significant difference in the steady-state blood drug concentration between the two groups, but there was a certain difference between the two groups after stopping the infusion of propofol. The serum drug concentration in the alcoholic group was slightly higher than that in the control group. This difference indicated that the metabolic rate was different between the two groups. Conclusion: alcoholism has a certain effect on propofol anesthesia, and alcoholics may have some tolerance to propofol anesthetic effect. However, the influence of drinking on the anesthetic effect of propofol was not, to a certain extent, caused by the influence of propofol metabolism, and the plasma concentration of propofol was not the key factor to cause the difference between drinkers and non-drinkers.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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