心脏瓣膜置换术患者丙泊酚靶控输注维持浓度与意识消失浓度关系的研究

发布时间：2018-11-06 19:14

【摘要】：目的探讨BIS监测下心脏瓣膜置换术患者丙泊酚维持浓度与意识消失浓度之间的关系。方法择期开胸心脏瓣膜置换术患者30例,男8例,女22例,年龄39~64岁,麻醉诱导采用丙泊酚阶梯血浆靶控输注,初始血浆浓度(Cp)设定为1.0μg/ml,当预测效应室浓度(Ce)达0.5μg/ml时,每隔1分钟以0.3μg/ml递增Cp,患者意识消失(LOC)时静注舒芬太尼0.8~1.0μg/kg、罗库溴铵0.6~0.9mg/kg,当BIS达50时将Cp调至Ce水平,肌松满意后行气管插管。所有患者均在中低温心肺转流(CPB)下进行手术。记录患者入室后安静状态(基础值)(T_0)、LOC时(T_1)、BIS值达到50时(T_2)、切皮时(T_3)、劈胸骨时(T_4)、CPB开始时(T_5)、复温时(T_6)、CPB结束时(T_7)、关胸时(T_8)、术毕(T_9)时的MAP、HR、CVP、心排血量(CO)、每搏量(SV)、全身血管阻力(SVR)、BIS、丙泊酚Cp和Ce值。分析LOC时丙泊酚Ce值与围术期各变量相关性。结果相关分析中,患者LOC时丙泊酚Ce值与基础值CO、SV呈明显正相关(P0.01),与年龄呈明显负相关(P0.05);T_2~T_9时丙泊酚Ce值与LOC时Ce值呈明显正相关(P0.01);回归分析中,T_2~T_9时丙泊酚Ce值与LOC时Ce值呈明显正相关(P0.01)。结论在瓣膜置换术患者中,丙泊酚靶控输注维持浓度与LOC时浓度具有明显相关性,LOC时的丙泊酚Ce值可为维持浓度的调整提供一定参考依据。
[Abstract]:Objective to investigate the relationship between propofol maintenance concentration and consciousness loss in patients with cardiac valve replacement monitored by BIS. Methods Thirty patients (8 males and 22 females) with elective open heart valve replacement, aged 39 to 64 years, were treated with propofol step plasma target-controlled infusion. The initial plasma concentration (Cp) was set at 1.0 渭 g / ml. When predictive effect chamber concentration (Ce) was 0.5 渭 g/ml, sufentanil 0.81.0 渭 g / kg, rocuronium 0.6 渭 g / kg were injected intravenously every 1 minute to increase the consciousness of Cp, patients to disappear (LOC) with 0.3 渭 g/ml. When BIS reached 50, Cp was adjusted to Ce level, then tracheal intubation was performed after satisfactory muscle relaxation. All patients underwent moderate hypothermia cardiopulmonary bypass (CPB). The patient's quiet state (base value) after entering the room (T _ S _ 0), LOC (T _ 1), BIS = 50), T _ (2), T _ 3 (T _ 3) and T _ 4), CPB (T _ 5) were recorded. MAP,HR,CVP, cardiac output at the end of T _ 6), CPB (T _ 7), chest closure (T _ 8), MAP,HR,CVP, cardiac output at T _ 9 (T _ 9), (SV), systemic vascular resistance (SVR), BIS, per stroke volume Propofol Cp and Ce. The correlation between propofol Ce and perioperative variables was analyzed during LOC. Results in correlation analysis, propofol Ce was positively correlated with basic CO,SV (P0.01), and negatively correlated with age (P0.05). The Ce value of propofol in T_2~T_9 was positively correlated with Ce value in LOC (P0.01), and the Ce value of propofol in T_2~T_9 was positively correlated with Ce value in LOC (P0.01). Conclusion in valvular replacement patients, propofol target-controlled infusion maintenance concentration has a significant correlation with the concentration of LOC. The Ce value of propofol during LOC can provide some reference for adjustment of maintenance concentration.
【作者单位】：安徽医科大学第一附属医院麻醉科;
【基金】：安徽医科大学第一附属医院国自然青年基金院内培育计划(2012KJ12)
【分类号】：R614

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