不同麻醉诱导剂量丙泊酚对病态肥胖患者心脏泵功能的影响

摘要

目的 评价不同麻醉诱导剂丙泊酚对病态肥胖患者心脏泵功能的影响.方法 将40例行腹腔镜Rouc-en-Y胃旁路手术的病态肥胖患者随机分为两组(n=20):去脂体质量组(LBW组)和总体质量组(TBW组).LBW组于诱导时丙泊酚剂量按照患者的去脂体质量kg×2.0 mg/kg计算,TBW组则按照患者总体质量计算.通过超声心动图监测麻醉前(T1)与丙泊酚给药1 min后(T2)患者心脏左室射血分数(LVEF)和每搏量(SV)变化情况;同时测量T1、T2两个时间点有创动脉压、无创动脉压、BIS值、SpO2值.结果 与T1比较,麻醉诱导后两组患者LVEF、SV均下降(P<0.05);与LBW组比较,麻醉诱导后TBW组对LVEF、SV影响较大(P<0.05);与T1比较,麻醉诱导后患者无创动脉血压、有创动脉血压、平均动脉压均下降(P<0.05);与LBW组比较,麻醉诱导后TBW组对无创动脉血压、有创动脉血压、平均动脉压影响较大(P<0.05);两组患者麻醉诱导后BIS均<50.结论 在保证麻醉深度的同时,LBW剂量丙泊酚诱导对病态肥胖患者心脏泵功能影响更小,作为丙泊酚的诱导剂量效果更好.%Objective To compare the effects of different doses of propofol on cardiac pump function in morbidly obese patients. Methods Forty morbidly obese patients undergoing laparoscopic Roux-en-Y gastric by-pass were randomly divided into lean body weight(LBW)group and total body weight(TBW)group,with 20 cases in each group.In LBW group,patients were induced by propofol with a dose according to LBW(kg)×2.0 mg/kg but in TBW group,patients were induced by propofol depending on TBW of the patients.We monitored the changes of left ventricular ejection fraction(LVEF)and stroke volume(SV)in patients before anesthetic induction(T1)and at 1 min(T2)after propofol administration.At the same time,we monitored invasive arterial pressure,noninvasive arterial pressure,BIS,and SpO2.Results Compared with those measured at T1,LVEF and SV were decreased af-ter the induction of anesthesia in the 2 groups(P < 0.05);compared with LBW,TBW had greater influence on LVEF and SV after the induction of anesthesia(P<0.05);compared with those at T1,non invasive arterial blood pressure,invasive arterial blood pressure and mean arterial pressure decreased after theinduction of anesthesia (P<0.05);compared with LBW,TBW had no significant effect on noninvasive arterial blood pressure,invasive arterial blood pressure and mean arterial pressure after the induction of anesthesia(P < 0.05);BIS was less than 50 after the induction of anesthesia in 2 groups. Conclusion Propofol induction with a LBW-dependent dose has less influence on cardiac pump function in morbidly obese patients while ensuring the depth of anesthesia.