本文關(guān)鍵詞：肥胖因素對全麻患者靶控輸注丙泊酚意識消失時半數(shù)有效血漿濃度的影響　出處：《河北醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

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【摘要】：目的：評價肥胖因素對全麻患者靶控輸注丙泊酚意識消失時半數(shù)有效血漿濃度的影響。 方法：擇期行全麻手術(shù)患者60例，年齡35～55歲，男女不限，，ASA分級Ⅰ或Ⅱ級。術(shù)前無心肺及肝腎功能異常,未長期服用鎮(zhèn)靜劑或阿片類藥物，無明顯的高血壓病史，無神經(jīng)、精神系統(tǒng)疾病，無聽力障礙。根據(jù)體重指數(shù)BMI［BMI=體重（kg）/身高（m）2］將患者分為3組（n=20）：正常體重組（C組），BMI＜25kg/m2；肥胖患者（BMI30～40kg/m2）按照隨機(jī)數(shù)字表法分為2組(n=20)：總體重給藥組（T組）和去脂體重給藥組（L組）。其中，C組和T組患者在麻醉誘導(dǎo)階段丙泊酚按照總體重作為體重輸入項，L組患者則按照去脂體重給藥。 無術(shù)前用藥，入室后開放外周上肢靜脈通路，常規(guī)監(jiān)測心電圖（ECG）、心率(HR)、脈搏血氧飽和度（SpO2）、腦電雙頻譜指數(shù)(BIS)，局麻下行橈動脈穿刺置管術(shù)監(jiān)測有創(chuàng)平均動脈壓(MAP）。三組均采用FreseniusInfusion System TCI系統(tǒng)以血漿濃度1.2μg/ml為起點靶控輸注丙泊酚，達(dá)到預(yù)期血漿濃度后每30秒增加0.3μg/ml，期間每隔10s由對前期試驗不知情的另一位麻醉醫(yī)師采用警覺／鎮(zhèn)靜評分(OAA／S)評價患者的意識狀態(tài)，直至患者至患者意識消失(OAA／S=1分)，記錄此時丙泊酚的血漿濃度，同時記錄此時患者的HR、MAP和BIS值，并記錄三組患者意識消失時所需時間及丙泊酚的總量。采用概率單位回歸分析（probit analysis）計算并比較三組患者意識消失時丙泊酚的EC50及其95％可信區(qū)間(95％CI)。 結(jié)果： 1三組患者的年齡、性別構(gòu)成比比較無統(tǒng)計學(xué)意義(P0.05)； 2三組患者患者誘導(dǎo)前心率、平均動脈壓、BIS值比較無顯著性差異(P0.05)； 3C組、T組與L組意識消失時丙泊酚血漿靶濃度EC50及其95％可信區(qū)間分別為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組與T組兩組意識消失時丙泊酚EC50比較有統(tǒng)計學(xué)差異(P0.05)，C組與L組兩組意識消失時丙泊酚EC50比較差異無統(tǒng)計學(xué)意義（P0.05）； 4C組、T組與L組意識消失時所需時間分別為362±6s、308±8s、367±5s。其中，C組與T組兩組意識消失時所需時間比較有統(tǒng)計學(xué)差異（P0.05），C組與L組兩組意識消失時所需時間比較差異無統(tǒng)計學(xué)意義（P0.05）。 結(jié)論：肥胖患者按照總體重和去脂體重靶控輸注丙泊酚意識消失時EC50分別為3.29μg/ml和3.90μg/ml，肥胖因素可降低全麻患者靶控輸注丙泊酚意識消失時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 鹵6 s-1, 308 鹵8 s, 367 鹵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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R614

【引證文獻(xiàn)】

相關(guān)碩士學(xué)位論文 前2條

1 張小光;失血對丙泊酚靶控輸注時血藥濃度和聽覺誘發(fā)電位指數(shù)的影響[D];河北北方學(xué)院;2015年

2 李曉晶;血液稀釋對靶控輸注丙泊酚血藥濃度的影響及丙泊酚全自動閉環(huán)靶控在臨床上的初步應(yīng)用研究[D];河北北方學(xué)院;2015年

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