本文關鍵詞：清醒濃度（MAC-awake）七氟醚對婦科全憑靜脈麻醉患者丙泊酚半數(shù)有效血漿靶濃度及血流動力學的影響　出處：《大連醫(yī)科大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 靶控輸注 腦電雙頻譜指數(shù) 清醒濃度七氟醚 序貫法

【摘要】：目的:對靶控輸注丙泊酚、舒芬太尼全憑靜脈麻醉的婦科手術患者,測定腦電雙頻譜指數(shù)50時的丙泊酚半數(shù)有效血漿靶濃度(Cp50),并觀察清醒濃度(MAC-awake)七氟醚對該值及血流動力學的影響。方法:婦科擇期行下腹部手術的患者,ASA分級Ⅰ-Ⅱ級,年齡18-65周歲,體重指數(shù)(BMI)18-32kg/m2。隨機分為2組:實驗組、吸入七氟醚組(S,17例)和全憑靜脈組、對照組(P,16例)。麻醉誘導:兩組患者均采用靜脈快速誘導,靶控輸注舒芬太尼(效應室濃度0.5ng/ml),靜脈注射0.2mg/kg的依托咪酯脂肪乳,待患者睫毛反射消失后,靜脈注射0.2mg/kg的順-苯磺酸阿曲庫銨。麻醉插管:麻醉誘導6min后,BIS值60,置入氣管導管。麻醉維持:S組吸入七氟醚,維持呼末麻醉氣體濃度0.33%(即清醒濃度(MAC-awake))。S組與P組均采用序貫法,靶控輸注丙泊酚。靶控輸注舒芬太尼,待舒芬太尼濃度降到0.2ng/ml時便以該靶濃度維持麻醉直至關腹。麻醉蘇醒:關腹后實驗組關七氟醚,兩組均停止輸注舒芬太尼并調(diào)整丙泊酚靶濃度維持BIS值50,縫皮前5分鐘停止靶控輸注丙泊酚。采集患者入室的基礎值(T0)、切皮(T,)、開腹(T2)、開腹探查(T3……12)、關腹(Tn)、術畢(Tn-1),共15個時間點的心率(HR)、平均動脈壓(MAP)、血氧飽和度(Sp02)、腦電雙頻譜指數(shù)(BIS值)及呼末二氧化碳濃度(EtCO2)。記錄兩組中每個患者的丙泊酚血漿靶濃度,利用統(tǒng)計學計算公式求丙泊酚的半數(shù)有效血漿靶濃度及其95%置信區(qū)間。術后24小時內(nèi)床旁隨訪:術后惡心嘔吐(PONV)及術中知曉的情況。結果:S組和P組最終納入患者例數(shù)分別為17例和16例,維持BIS值50時丙泊酚的Cp50及95%CI分別為 1.61 μg/ml(95%CI 1.57-1.66 μg/ml)和2.17μg/ml(95%CI 2.07-2.29 μg/ml),S組比P組丙泊酚所需濃度低(P0.05),差異有統(tǒng)計學意義。結論:婦科下腹部手術腦電雙頻譜指數(shù)50時,吸入清醒MAC濃度七氟醚組與全憑靜脈麻醉丙泊酚Cp50及95%CI分別為:1.61 μg/ml(95%CI 1.57-1.66 μg/ml)和2.17μg/ml(95%CI 2.07-2.29 μg/ml)。兩種麻醉方法均能維持血流動力學平穩(wěn),差異無統(tǒng)計學意義(P0.05)。
[Abstract]:Objective: to target controlled infusion of propofol, sufentanil with total intravenous anesthesia for patients undergoing gynecological surgery, 50 propofol half effective target plasma concentration determination of bispectral index (Cp50), and concentration (MAC-awake) to observe the effect of sevoflurane on the value and hemodynamics. Methods: gynecological elective lower abdominal surgery patients with ASA grade I-II, age 18-65 years of age, body mass index (BMI) of 18-32kg/m2. were randomly divided into 2 groups: experimental group, sevoflurane group (S, n = 17) and total intravenous group, control group (P, n = 16). The induction of anesthesia: two groups of patients were treated with intravenous rapid induction. Target controlled infusion of sufentanil (effectcompartmentconcentration 0.5ng/ml), intravenous injection of 0.2mg/kg of etomidate fat emulsion for patients, eyelash reflex disappeared after intravenous injection of 0.2mg/kg CIS atracurium anesthesia intubation anesthesia. After 6min induction, the BIS value is 60, the tracheal catheter anesthesia: S. 緇勫惛鍏ヤ竷姘熼啔,緇存寔鍛兼湯楹婚唹姘斾綋嫻撳害0.33%(鍗蟲竻閱掓祿搴，

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