离子迁移谱技术检测呼出气中丙泊酚的浓度与BIS监测麻醉深度之间的相关性研究

发布时间：2018-05-28 18:13

本文选题：离子迁移谱技术 + BIS　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:丙泊酚是目前临床上普遍使用静脉麻醉药,由于其血药浓度不能实时监测来确定适宜的麻醉深度,麻醉时容易造成麻醉过深、或者麻醉过浅而发生术中知晓等严重问题。本研究将针对大连市中心医院耳鼻咽喉科临床短小全麻手术来进行研究。本研究应用离子迁移谱技术来检测静脉给予丙泊酚病人的呼出气中丙泊酚的浓度与BIS脑电双频谱监测系统的麻醉深度之间的相关性研究。方法:中国科学院大连化学物理研究所成功开发研制出了离子迁移谱技术(Ion Mobility Spectrometer,IMS)用于麻醉剂的在线监测分析,其技术已达到国际领先水平包括:血浆药物浓度的快速分析仪,呼出气麻醉深度监护仪。本研究选择大连市中心医院耳鼻咽喉科短小全麻手术的病人20例,ASA评级I~II级,年龄20-60岁,体重指数(body mass index,BMI)28kg/m2,本研究选择的耳鼻咽喉科手术种类包括:功能性鼻窦手术、鼻中隔偏曲矫正术、鼻腔肿物切除术、扁桃体剥离术、茎突过长截断术、鼓室成型术等。病人均无麻醉前用药,采用气管内插管全凭静脉麻醉。麻醉诱导:丙泊酚2.5mg/kg,芬太尼1-2μg/kg,罗库溴铵0.6mg/kg达到肌松条件后进行气管插管、机械通气。麻醉维持:丙泊酚TCI靶浓度2.5~5μg/m L,瑞芬太尼持续输注0.1~0.25μg/(kg·min),一般不需要追加罗库溴铵维持肌松,术毕时停止输注丙泊酚及瑞芬太尼,停药10min后送苏醒室。一般监测:心电图、心率、无创动脉血压、脉搏氧饱和度、呼气末二氧化碳分压,并记录潮气量和分钟通气量,术中使用BIS脑电双频谱监测系统来监测麻醉深度。记录气管插管、气管拔管等特殊事件。设置观察时点:开始记录诱导后的前600秒呼气中丙泊酚浓度和BIS值。诱导时静脉推注丙泊酚2.5mg/kg后观察测量呼气中丙泊酚浓度值和双谱指数(BIS)值。主要观察检测呼气中丙泊酚的浓度与BIS值的相关性,次要观察点为呼气中丙泊酚浓度的最高值和最低值BIS值的相关性。结果:在推注丙泊酚后分别在42±21秒监测到呼气中丙泊酚浓度和在49±11秒检测到BIS值开始下降(P30.29)。监测呼气中丙泊酚峰值浓度为9.1±2.3ppb的时间在204±53秒和监测BIS最低值23±4的时间215±59秒(P=0.57)。结论:检测静脉给予丙泊酚的病人其呼出气中丙泊酚的浓度与BIS脑电双频谱监测系统的麻醉深度之间有相关性。呼出气中丙泊酚的浓度与BIS脑电双频谱系统的麻醉深度之间具有相关性数学模型,此模型用于调节麻醉剂的静脉注射量,可以保障病人的手术顺利和安全。中国科学院大连化学物理研究所成功开发研制出了离子迁移谱技术(Ion Mobility Spectrometer,IMS)可用于麻醉剂的在线监测分析。
[Abstract]:Objective: propofol is a widely used intravenous anesthetic in clinic at present. Because the concentration of propofol can not be monitored in real time to determine the appropriate depth of anesthesia, it is easy to cause too deep anesthesia or too shallow anesthesia to cause serious problems such as knowing during operation. This study will focus on clinical short general anesthesia in Department of Otorhinolaryngology, Dalian Central Hospital. The purpose of this study was to investigate the correlation between the concentration of propofol in the exhalation of intravenous propofol patients and the anesthetic depth of BIS bispectral monitoring system. Methods: ion transfer Spectroscopy (Ion Mobility Spectrometer) was successfully developed by Dalian Institute of Chemical Physics, Chinese Academy of Sciences, for on-line monitoring and analysis of anesthetics. The technology has reached the international leading level, including a fast analyzer for plasma drug concentration. Exhalation Anesthesia depth Monitor. In this study, 20 patients with short general anesthesia in Department of Otolaryngology, Department of Otolaryngology, Dalian Central Hospital, were selected for I~II grade, age 20-60 years old, body mass index (BMI) of 28 kg / m ~ (2). The types of otorhinolaryngology surgery selected in this study included: functional sinus surgery. Nasal septum deviation correction, nasal mass resection, tonsillectomy, long styloid process amputation, tympanoplasty, etc. All patients were treated with intratracheal intubation only by intravenous anesthesia without anaesthesia. Anesthesia induction: propofol 2.5 mg / kg, fentanyl 1-2 渭 g / kg, rocuronium 0.6mg/kg reached muscle relaxation condition for tracheal intubation and mechanical ventilation. Anesthesia maintenance: the target concentration of propofol TCI was 2.55 渭 g / mL, remifentanil was continuously infused with 0.1 ~ 0.25 渭 g/(kg / min, no additional rocuronium was needed to maintain muscle relaxation, the infusion of propofol and remifentanil was stopped at the end of operation, and the remifentanil was withdrawn from 10min to the recovery room. General monitoring: electrocardiogram, heart rate, non-invasive arterial blood pressure, pulse oxygen saturation, end-expiratory carbon dioxide partial pressure, tidal volume and minute ventilation volume. The anesthetic depth was monitored by BIS bispectral monitoring system. Record special events such as tracheal intubation and tracheal extubation. Set observation time: start recording propofol concentrations and BIS values in the first 600 seconds after induction. The concentration of propofol and bispectral index (bispectral index) were measured after intravenous injection of propofol 2.5mg/kg during induction. The correlation between propofol concentration in breath and BIS value was observed. The secondary observation point was the correlation between the highest and lowest BIS values of propofol concentration in breath. Results: the concentration of propofol in breath was detected at 42 卤21 seconds after injection of propofol and the BIS value began to decrease in 49 卤11 seconds. The time of peak concentration of propofol 9.1 卤2.3ppb was 204 卤53 seconds and the lowest value of BIS 23 卤4 was 215 卤59 seconds. Conclusion: there is a correlation between the concentration of propofol in exhalation and the anesthetic depth of BIS bispectral monitoring system. There is a mathematical model between the concentration of propofol in exhalation and the anesthetic depth of BIS bispectral electroencephalogram system. This model is used to regulate the intravenous injection of anesthetic, which can ensure the smooth and safe operation of patients. Ion transfer Spectroscopy (Ion Mobility Spectrometer) has been successfully developed for the on-line monitoring and analysis of anesthetics by Dalian Institute of Chemical Physics, Chinese Academy of Sciences.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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