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

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1.0 μg/ml,当预测效应室浓度(Ce) 达0.5 μg/ml时,每隔1分钟以0.3 μg/ml递增Cp,患者意识消失(LOC)时静注舒芬太尼0.8~1.0 μg/kg、罗库溴铵0.6~0.9 mg/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)(T0)、LOC时(T1)、BIS值达到50时(T2)、切皮时(T3)、劈胸骨时(T4)、CPB开始时(T5)、复温时(T6)、CPB结束时(T7)、关胸时(T8)、术毕 (T9) 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(P<0.01),与年龄呈明显负相关(P<0.05);T2~T9时丙泊酚Ce值与LOC时Ce值呈明显正相关(P<0.01);回归分析中,T2~T9时丙泊酚Ce值与LOC时Ce值呈明显正相关(P<0.01).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.%Objective To investigate the relationship between maintaining concentration and loss of consciousness (LOC) concentration of propofol target controlled infusion (TCI) in patients undergoing heart valve replacement.Methods Thirty patients undergoing elective heart valve replacement were enrolled to receive propofol by ladder plasma TCI for anesthesia induction,8 males and 22 females.The initial plasma concentration (Cp) of propofol was set to 1.0 μg/ml,0.3 μg/ml Cp was increased every 1 min until LOC when the prediction effect-cite concentration (Ce) reached 0.5 μg/ml,then sufentanil 0.8-1.0 μg/kg and rocuronium 0.6-0.9 mg/kg were given for intubation.When BIS reached 50,Cp was decreased to the level of Ce.All the surgeries were performed under hypothermia CPB.MAP,HR,CVP,CO,SV,SVR,BIS,propofol Cp and Ce values were recorded at baseline (T0),LOC (T1),BIS reached 50 (T2),and other time points during operation (T3-T9).The correlation analysis between propofol Ce at LOC and perioperative variables were completed.Results In correlation analysis,there was a significant positive correlation between propofol Ce at LOC and baseline CO,SV (P<0.01),there was a significant negative correlation between propofol Ce at LOC and age (P<0.05),there was a significant positive correlation between propofol Ce at LOC and propofol Ce at T2-T9(P<0.01).Conclusion In patients undergoing valvular replacement,the Ce of propofol at maintenance are related to the concentration of propofol at LOC,which is helpful for adjusting the Ce of propofol at maintenance according to the Ce of propofol at LOC.