【摘要】：目的探討B(tài)IS監(jiān)測(cè)下心臟瓣膜置換術(shù)患者丙泊酚維持濃度與意識(shí)消失濃度之間的關(guān)系。方法擇期開胸心臟瓣膜置換術(shù)患者30例,男8例,女22例,年齡39~64歲,麻醉誘導(dǎo)采用丙泊酚階梯血漿靶控輸注,初始血漿濃度(Cp)設(shè)定為1.0μg/ml,當(dāng)預(yù)測(cè)效應(yīng)室濃度(Ce)達(dá)0.5μg/ml時(shí),每隔1分鐘以0.3μg/ml遞增Cp,患者意識(shí)消失(LOC)時(shí)靜注舒芬太尼0.8~1.0μg/kg、羅庫(kù)溴銨0.6~0.9mg/kg,當(dāng)BIS達(dá)50時(shí)將Cp調(diào)至Ce水平,肌松滿意后行氣管插管。所有患者均在中低溫心肺轉(zhuǎn)流(CPB)下進(jìn)行手術(shù)。記錄患者入室后安靜狀態(tài)(基礎(chǔ)值)(T_0)、LOC時(shí)(T_1)、BIS值達(dá)到50時(shí)(T_2)、切皮時(shí)(T_3)、劈胸骨時(shí)(T_4)、CPB開始時(shí)(T_5)、復(fù)溫時(shí)(T_6)、CPB結(jié)束時(shí)(T_7)、關(guān)胸時(shí)(T_8)、術(shù)畢(T_9)時(shí)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時(shí)丙泊酚Ce值與圍術(shù)期各變量相關(guān)性。結(jié)果相關(guān)分析中,患者LOC時(shí)丙泊酚Ce值與基礎(chǔ)值CO、SV呈明顯正相關(guān)(P0.01),與年齡呈明顯負(fù)相關(guān)(P0.05);T_2~T_9時(shí)丙泊酚Ce值與LOC時(shí)Ce值呈明顯正相關(guān)(P0.01);回歸分析中,T_2~T_9時(shí)丙泊酚Ce值與LOC時(shí)Ce值呈明顯正相關(guān)(P0.01)。結(jié)論在瓣膜置換術(shù)患者中,丙泊酚靶控輸注維持濃度與LOC時(shí)濃度具有明顯相關(guān)性,LOC時(shí)的丙泊酚Ce值可為維持濃度的調(diào)整提供一定參考依據(jù)。
[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.
【作者單位】： 安徽醫(yī)科大學(xué)第一附屬醫(yī)院麻醉科;
【基金】：安徽醫(yī)科大學(xué)第一附屬醫(yī)院國(guó)自然青年基金院內(nèi)培育計(jì)劃(2012KJ12)
【分類號(hào)】：R614

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