肥胖因素对全麻患者靶控输注丙泊酚意识消失时半数有效血浆浓度的影响

发布时间：2018-01-16 19:06

本文关键词：肥胖因素对全麻患者靶控输注丙泊酚意识消失时半数有效血浆浓度的影响　出处：《河北医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：评价肥胖因素对全麻患者靶控输注丙泊酚意识消失时半数有效血浆浓度的影响。方法：择期行全麻手术患者60例，年龄35～55岁，男女不限，，ASA分级Ⅰ或Ⅱ级。术前无心肺及肝肾功能异常,未长期服用镇静剂或阿片类药物，无明显的高血压病史，无神经、精神系统疾病，无听力障碍。根据体重指数BMI［BMI=体重（kg）/身高（m）2］将患者分为3组（n=20）：正常体重组（C组），BMI＜25kg/m2；肥胖患者（BMI30～40kg/m2）按照随机数字表法分为2组(n=20)：总体重给药组（T组）和去脂体重给药组（L组）。其中，C组和T组患者在麻醉诱导阶段丙泊酚按照总体重作为体重输入项，L组患者则按照去脂体重给药。无术前用药，入室后开放外周上肢静脉通路，常规监测心电图（ECG）、心率(HR)、脉搏血氧饱和度（SpO2）、脑电双频谱指数(BIS)，局麻下行桡动脉穿刺置管术监测有创平均动脉压(MAP）。三组均采用FreseniusInfusion System TCI系统以血浆浓度1.2μg/ml为起点靶控输注丙泊酚，达到预期血浆浓度后每30秒增加0.3μg/ml，期间每隔10s由对前期试验不知情的另一位麻醉医师采用警觉／镇静评分(OAA／S)评价患者的意识状态，直至患者至患者意识消失(OAA／S=1分)，记录此时丙泊酚的血浆浓度，同时记录此时患者的HR、MAP和BIS值，并记录三组患者意识消失时所需时间及丙泊酚的总量。采用概率单位回归分析（probit analysis）计算并比较三组患者意识消失时丙泊酚的EC50及其95％可信区间(95％CI)。结果： 1三组患者的年龄、性别构成比比较无统计学意义(P0.05)； 2三组患者患者诱导前心率、平均动脉压、BIS值比较无显著性差异(P0.05)； 3C组、T组与L组意识消失时丙泊酚血浆靶浓度EC50及其95％可信区间分别为3.82（3.73～3.90）μg/ml、3.29（3.20～3.37）μg/ml、3.90（3.80～3.91）μg/ml。其中，C组与T组两组意识消失时丙泊酚EC50比较有统计学差异(P0.05)，C组与L组两组意识消失时丙泊酚EC50比较差异无统计学意义（P0.05）； 4C组、T组与L组意识消失时所需时间分别为362±6s、308±8s、367±5s。其中，C组与T组两组意识消失时所需时间比较有统计学差异（P0.05），C组与L组两组意识消失时所需时间比较差异无统计学意义（P0.05）。结论：肥胖患者按照总体重和去脂体重靶控输注丙泊酚意识消失时EC50分别为3.29μg/ml和3.90μg/ml，肥胖因素可降低全麻患者靶控输注丙泊酚意识消失时EC50。
[Abstract]:Aim: to evaluate the effect of obesity factors on half effective plasma concentration of propofol in patients with general anesthesia when awareness of propofol disappeared. Methods: 60 patients (35 ~ 55 years old) undergoing elective general anesthesia were enrolled in this study. There were no abnormal heart, lung, liver and kidney function before operation, no sedatives or opiates for a long time. No obvious history of hypertension, no neurological, mental system diseases. No hearing impairment. According to the body mass index (BMI), the patients were divided into three groups: normal body weight group C group (BMI < 25 kg / m 2); Obese patients were randomly divided into two groups according to random digital table: total body weight group (T group) and fat-free body weight group (group L). Patients in group C and group T were given propofol according to the total body weight as an input item during anesthesia induction. No drugs were used before operation, the peripheral upper limb vein was opened after entering the room, ECG, HR, SPO _ 2 and bispectral index (BIS) were routinely monitored. Percutaneous radial artery catheterization under local anesthesia for the monitoring of mean arterial pressure (MAPP). Three groups were injected propofol with plasma concentration 1.2 渭 g / ml by FreseniusInfusion System TCI system. The plasma concentration was increased by 0.3 渭 g / ml at 30 seconds. At intervals of 10 seconds, another anesthesiologist who was not aware of the preliminary trial evaluated the patient's consciousness status by using an alert / sedation score (OAA / S). The plasma concentration of propofol was recorded until the patient's consciousness disappeared, and the HRMA map and BIS of the patient were recorded at the same time. The time required for consciousness loss and the total amount of propofol were recorded in the three groups. Probit analysis was used in regression analysis of probit. The EC50 of propofol and its 95% CI were calculated and compared in three groups when consciousness disappeared. Results: (1) there was no significant difference in age and sex ratio among the three groups (P 0.05); 2There was no significant difference in heart rate and mean arterial pressure (BIS) between the three groups before induction (P 0.05). The plasma target concentration of propofol EC50 and its 95% confidence interval were 3.82 渭 g / ml and 3.73 渭 g / ml when consciousness disappeared in group T and group L respectively. 3.29 ~ 3.20 ~ 3.37) 渭 g / ml ~ (3.90) ~ 3.80 ~ 3.91) 渭 g 路ml ~ (-1). There was significant difference in propofol EC50 between group C and group T when consciousness disappeared (P0.05). There was no significant difference in propofol EC50 between group C and group L when consciousness disappeared (P 0.05). 4The time required for consciousness disappearance in group C and group L was 362 卤6 s-1, 308 卤8 s, 367 卤5 s, respectively. There was statistical difference between group C and group T when consciousness disappeared. There was no significant difference between group C and group L when consciousness was lost. Conclusion: the EC50 of obese patients was 3.29 渭 g / ml and 3.90 渭 g / ml respectively when the consciousness of propofol was lost according to total body weight and fat-free body weight. Obesity factors can reduce EC50 when the consciousness of target controlled infusion of propofol disappears in patients with general anesthesia.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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