丙泊酚靶控输注意识消失和苏醒时效应室浓度的相关性研究

发布时间：2018-03-01 02:03

  本文关键词： 丙泊酚靶控输注 效应室浓度 意识消失 苏醒 起始血浆靶浓度　出处：《广州医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：【目的】 观察采用不同方式(快速TCI和分步TCI)丙泊酚靶控输注时的意识消失效应室浓度和苏醒效应室浓度，研究意识消失时效应室浓度和苏醒效应室浓度的相关性，以期为临床个体化用药提供依据。 【资料与方法】 选择在腰硬联合麻醉下行膝关节镜手术的病人40例，年龄18～50岁，BMI20～28kg/m2，ASAⅠ至Ⅱ级。采用计算机随机数字法将病人随机分为快速TCI组(F组)和分步TCI组(S组)，每组20例。快速TCI组(F组)设置起始血浆靶浓度为4ug/ml并开始输注丙泊酚，在病人意识消失后将血浆浓度下调，使BIS值稳定在40～60之间并维持30min后停药；分步TCI组(S组)的起始血浆靶浓度设置为1ug/ml并开始输注丙泊酚，在效应室浓度与血浆浓度达到平衡后，将血浆靶浓度以0.5ug/ml递增，使效应室浓度再次与血浆浓度平衡后，重复上述步骤直至病人意识消失，而后调整血浆靶浓度使BIS在40～60之间并维持30min后停止给药。停止给药后每10s轻拍病人三角肌并呼唤病人姓名，直至病人有反应。记录两组病人意识消失时效应室浓度、苏醒时效应室浓度、心率、收缩压、平均动脉压、血氧饱和度、意识消失时的丙泊酚用量、丙泊酚输注总量、从清醒到意识消失所用时间以及最高感觉阻滞平面。 【结果】 1、快速TCI组：意识消失时效应室为1.82±0.34ug/ml，苏醒时效应室浓度为1.89±0.36ug/ml；分步TCI组：意识消失时效应室为2.00±0.31ug/ml，苏醒时效应室浓度为1.84±0.35ug/ml。 2、快速TCI组和分步TCI组中意识消失时效应室浓度与苏醒时效应室浓度的相关系数r分别为0.736和0.804，两组意识消失时效应室浓度和苏醒时效应室浓度均高度相关。两组的相关系数无显著性差异(Z=-0.4902,P=0.6240,P＞0.05)。 3、分步TCI组中意识消失时效应室浓度高于苏醒时效应室浓度，平均差为0.17±0.20ug/ml;快速TCI组中两者差异无统计学意义。 4、两组的丙泊酚输注总量无显著性差异(t=-2.006，P=0.052，P＞0.05)，但从清醒到意识消失的丙泊酚输注量差异有统计学意义(t=-6.45,P＜0.01)，快速TCI组从清醒到意识消失的丙泊酚输注量明显少于分步TCI组，从清醒到意识消失所用时间明显少于分步TCI组(t=-14.19，，P＜0.01)。 5、意识消失时两组的MAP、HR有显著性差异，快速TCI组的MAP和HR均高于分步TCI组。 6、两组出现的丙泊酚相关并发症包括低血压、呼吸抑制和呛咳均无显著性差异(P＞0.05)。 【结论】 对于ASAⅠ～Ⅱ级中青年病人，在无伤害性刺激的情况下，丙泊酚靶控输注，无论快速TCI或分步TCI，意识消失时效应室浓度和苏醒时效应室浓度呈高度线性正相关，意识消失时的效应室浓度可以作为推测苏醒时效应室浓度的参考依据。
[Abstract]:[purpose]. The effects of propofol target-controlled infusion were observed in different ways (fast TCI and stepwise TCI). In order to provide the basis for clinical individualized drug use. [information and methods]. Forty patients were selected for knee arthroscopy under combined spinal-epidural anesthesia. The patients were randomly divided into two groups: rapid TCI group (group F) and step TCI group (group S, n = 20). Group F (n = 20), group F (n = 20), group F (n = 20), group F (n = 20), group F (n = 20), group F (n = 20): the target concentration of plasma was 4ugrml in fast TCI group (n = 20) and propofol was infused. After the patient's consciousness disappeared, the plasma concentration was down-regulated, the BIS value was stabilized between 40 ~ 60 and maintained for 30 minutes, the initial plasma target concentration of the TCI group was set to 1ug-1 / ml and the propofol was infused. After the balance between the effect chamber concentration and the plasma concentration was achieved, the target concentration of the plasma was increased by 0.5ugr / ml, so that the effect chamber concentration was again balanced with the plasma concentration, and the above steps were repeated until the patient's consciousness disappeared. Then the plasma target concentration was adjusted to make BIS between 40 and 60 and maintained for 30 minutes. After stopping the administration, the deltoid muscles of the patient were patted and the patient's name was called until the patient had a response. The effect chamber concentration was recorded when the consciousness of the two groups disappeared. Effect ventricular concentration, heart rate, systolic blood pressure, mean arterial pressure, blood oxygen saturation, propofol dosage when consciousness disappeared, total infusion of propofol, time from waking to conscious disappearance and maximum sensory block level. [results]. 1. In the rapid TCI group, the effect chamber was 1.82 卤0.34ug-1 / ml at the time of consciousness disappearance, and the concentration of the effector chamber was 1.89 卤0.36ugr / ml when the consciousness disappeared, while in the step TCI group, the effect chamber was 2.00 卤0.31ug / ml when the consciousness disappeared, and the concentration of the effector chamber was 1.84 卤0.35ugr / ml when the consciousness disappeared. 2. The correlation coefficients between the concentration of the effector ventricle at the time of consciousness disappearance and the concentration of the effector ventricle in the fast TCI group and the step TCI group were 0.736 and 0.804, respectively. There was a high correlation between the concentration of the effector chamber when the consciousness disappeared and the concentration of the effect chamber at the time of awakening in both groups. There was no significant difference in correlation coefficient between the two groups (P > 0.05). 3. The concentration of the effector ventricle in the stepwise TCI group was higher than that in the waking group when the consciousness disappeared, the average difference was 0.17 卤0.20ug / ml, but there was no significant difference between the two groups in the fast TCI group. (4) there was no significant difference in the total amount of propofol infusion between the two groups. However, there was a significant difference between the two groups in propofol infusion from awake to conscious disappearance (P < 0.01). The propofol infusion volume in fast TCI group was significantly less than that in step TCI group. It took less time from consciousness to consciousness to disappear than that of stepwise TCI group (P < 0.01). 5. There was a significant difference between the two groups when consciousness disappeared. The MAP and HR of fast TCI group were higher than that of step TCI group. 6. There was no significant difference in propofol related complications between the two groups, including hypotension, respiratory depression and cough (P > 0.05). [conclusion]. For young and middle-aged ASA patients of grade 鈪

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