本文關鍵詞： 丙泊酚靶控輸注 效應室濃度 意識消失 蘇醒 起始血漿靶濃度　出處：《廣州醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：【目的】 觀察采用不同方式(快速TCI和分步TCI)丙泊酚靶控輸注時的意識消失效應室濃度和蘇醒效應室濃度，研究意識消失時效應室濃度和蘇醒效應室濃度的相關性，以期為臨床個體化用藥提供依據(jù)。 【資料與方法】 選擇在腰硬聯(lián)合麻醉下行膝關節(jié)鏡手術的病人40例，年齡18～50歲，BMI20～28kg/m2，ASAⅠ至Ⅱ級。采用計算機隨機數(shù)字法將病人隨機分為快速TCI組(F組)和分步TCI組(S組)，每組20例�？焖賂CI組(F組)設置起始血漿靶濃度為4ug/ml并開始輸注丙泊酚，在病人意識消失后將血漿濃度下調(diào)，使BIS值穩(wěn)定在40～60之間并維持30min后停藥；分步TCI組(S組)的起始血漿靶濃度設置為1ug/ml并開始輸注丙泊酚，在效應室濃度與血漿濃度達到平衡后，將血漿靶濃度以0.5ug/ml遞增，使效應室濃度再次與血漿濃度平衡后，重復上述步驟直至病人意識消失，而后調(diào)整血漿靶濃度使BIS在40～60之間并維持30min后停止給藥。停止給藥后每10s輕拍病人三角肌并呼喚病人姓名，直至病人有反應。記錄兩組病人意識消失時效應室濃度、蘇醒時效應室濃度、心率、收縮壓、平均動脈壓、血氧飽和度、意識消失時的丙泊酚用量、丙泊酚輸注總量、從清醒到意識消失所用時間以及最高感覺阻滯平面。 【結果】 1、快速TCI組：意識消失時效應室為1.82±0.34ug/ml，蘇醒時效應室濃度為1.89±0.36ug/ml；分步TCI組：意識消失時效應室為2.00±0.31ug/ml，蘇醒時效應室濃度為1.84±0.35ug/ml。 2、快速TCI組和分步TCI組中意識消失時效應室濃度與蘇醒時效應室濃度的相關系數(shù)r分別為0.736和0.804，兩組意識消失時效應室濃度和蘇醒時效應室濃度均高度相關。兩組的相關系數(shù)無顯著性差異(Z=-0.4902,P=0.6240,P＞0.05)。 3、分步TCI組中意識消失時效應室濃度高于蘇醒時效應室濃度，平均差為0.17±0.20ug/ml;快速TCI組中兩者差異無統(tǒng)計學意義。 4、兩組的丙泊酚輸注總量無顯著性差異(t=-2.006，P=0.052，P＞0.05)，但從清醒到意識消失的丙泊酚輸注量差異有統(tǒng)計學意義(t=-6.45,P＜0.01)，快速TCI組從清醒到意識消失的丙泊酚輸注量明顯少于分步TCI組，從清醒到意識消失所用時間明顯少于分步TCI組(t=-14.19，，P＜0.01)。 5、意識消失時兩組的MAP、HR有顯著性差異，快速TCI組的MAP和HR均高于分步TCI組。 6、兩組出現(xiàn)的丙泊酚相關并發(fā)癥包括低血壓、呼吸抑制和嗆咳均無顯著性差異(P＞0.05)。 【結論】 對于ASAⅠ～Ⅱ級中青年病人，在無傷害性刺激的情況下，丙泊酚靶控輸注，無論快速TCI或分步TCI，意識消失時效應室濃度和蘇醒時效應室濃度呈高度線性正相關，意識消失時的效應室濃度可以作為推測蘇醒時效應室濃度的參考依據(jù)。
[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 鹵0.34ug-1 / ml at the time of consciousness disappearance, and the concentration of the effector chamber was 1.89 鹵0.36ugr / ml when the consciousness disappeared, while in the step TCI group, the effect chamber was 2.00 鹵0.31ug / ml when the consciousness disappeared, and the concentration of the effector chamber was 1.84 鹵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 鹵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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