中国组织工程研究

中国组织工程研究 ›› 2018, Vol. 22 ›› Issue (30): 4835-4840.doi: 10.3969/j.issn.2095-4344.0971

• 药物控释材料 drug delivery materials • 上一篇    下一篇

麻醉诱导期梯度效应室靶控输注丙泊酚应用对老年患者围术期血流动力学和苏醒期的影响

刘 霞，王文娟，吴雪梅，谢 红   

  1. 苏州大学附属第二医院，江苏省苏州市 215004
  • 收稿日期:2018-05-10 出版日期:2018-10-28 发布日期:2018-10-28
  • 通讯作者: 谢红，主任医师，苏州大学附属第二医院麻醉科，江苏省苏州市 215004
  • 作者简介:刘霞，女，1983年生，山西省晋城市人，汉族，2009年苏州大学毕业，硕士，主治医师，主要从事围术期的心脏保护研究。

Effect of target controlled infusion of propofol on perioperative hemodynamics and awakening period in elderly patients

Liu Xia, Wang Wen-juan, Wu Xue-mei, Xie Hong   

  1. Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
  • Received:2018-05-10 Online:2018-10-28 Published:2018-10-28
  • Contact: Xie Hong, Chief physician, Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
  • About author:Liu Xia, Master, Attending physician, Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China

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摘要：

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文题释义：
靶控输注：是以药代-药效动力学理论为依据，利用计算机对药物在体内过程、效应过程进行模拟，并寻找到最合理的用药方案，继而控制药物注射泵，实现血药浓度或效应部位浓度稳定于预期值(靶浓度值)，控制麻醉深度，并根据临床需要可随时调整给药系统。靶控输注可迅速达到并稳定于靶浓度，诱导时血流动力学平稳、麻醉深度易于控制、麻醉过程平稳，还可预测患者苏醒和恢复时间，使用简便、精确、可控性好。
丙泊酚：通过激活GABA受体-氯离子复合物，发挥镇静催眠作用，其高亲脂性，蛋白结合率为97%-98%。丙泊酚对循环系统有抑制作用，作全麻诱导时常可引起明显的血压下降，心肌血液灌注及耗氧量下降，外周血管阻力降低，对心率影响不大。丙泊酚呼吸抑制作用明显，可抑制二氧化碳的通气反应，心脏病患者更显著，自主呼吸恢复时间3-5 min，其主要适用于静脉全麻诱导、“全静脉麻醉”的组成部分或麻醉辅助药。其不良反应为可能发生低血压和短暂性呼吸暂停，偶见惊厥和角弓反张的癫痫样运动等，发生概率均较低，药物安全性较好。
 
 
背景：临床采用血浆或效应室靶控输注进行麻醉诱导可出现滞后及超射现象，影响患者循环系统血流动力学，出现不同的变化。
目的：对比麻醉诱导期不同方式靶控输注丙泊酚对老年患者围术期血流动力学和苏醒期的影响。
方法：将行腹部手术的92例老年患者随机分4组进行麻醉诱导，每组23例，Ⅰ组进行血浆靶控输注丙泊酚，Ⅱ组进行效应室靶控输注丙泊酚，Ⅲ组进行梯度血浆靶控输注丙泊酚，Ⅳ组进行梯度效应室靶控输注丙泊酚。麻醉诱导前、诱导后气管插管前、插管时、插管后即刻及插管后5 min，比较4组血流动力学指标(心排指数、平均动脉压、心率的变化)；停止麻醉后，观察患者苏醒期情况(呼吸恢复时间、呼之睁眼时间、拔管时间、躁动评分、意识状态OAAS评分)；麻醉诱导前及术后6，24，48 h，进行认知功能MMSE评分测评。

结果与结论：①与麻醉诱导前比较，4组诱导后气管插管前的心排指数、平均动脉压均降低(P < 0.05)，心率明显升高(P < 0.05)；在诱导后气管插管前，Ⅳ组的心排指数、平均动脉压下降幅度明显低于其余3组(P < 0.05)，心率明显低于其余3组(P < 0.05)；在插管时、插管后即刻及插管后5 min，4组间各指标比较无差异；②Ⅳ组的呼吸恢复时间、呼之睁眼时间、拔管时间明显短于其余3组(P < 0.05)，躁动评分、OAAS评分明显低于其余3组(P < 0.05)；③与麻醉诱导前比较，4组术后MMSE评分均有降低；Ⅳ组术后6，24 h的MMSE评分均高于其余3组(P < 0.05)；④结果表明：对老年患者进行麻醉时，采用梯度效应室靶控输注丙泊酚进行诱导麻醉，不仅不影响麻醉效果，还可减轻对患者循环系统的影响，且术后麻醉恢复较快。

ORCID: 0000-0002-4658-4916(刘霞)

关键词: 靶控输注, 丙泊酚, 围术期, 血流动力学, 缓释材料, 生物材料

Abstract:

BACKGROUND: Clinical use of plasma or target controlled infusion for anesthesia induction may lead to hysteresis and over-shoot, resulting in hemodynamic changes of the circulatory system in patients.

OBJECTIVE: To compare the effects of different target controlled infusions of propofol on the perioperative hemodynamics and awakening period of the elderly patients.
METHODS: Ninety-two elderly patients scheduled for abdominal surgeries were randomly divided into four groups for induction of anesthesia, 23 cases in each group: group I of plasma target controlled infusion of propofol, group II of effect-compartment target controlled infusion of propofol, group III of gradient plasma target controlled infusion of propofol, and group IV of gradient effect-compartment target controlled infusion of propofol. Hemodynamic indexes (cardiac index, mean arterial pressure, heart rate changes) were compared among four groups before anesthesia induction, after anesthesia induction but before intubation, during intubation, immediately after endotracheal intubation and 5 minutes after intubation. After termination of anesthesia, the situation of patients in awakening period, including breathing recovery time, the time to open eyes on verbal command, extubation time, restlessness, and the Observer’s Assessment of Alertness/Sedation (OAAS) score, was observed before anesthesia induction and 6, 24, 48 hours after surgery. Mini-Mental State Examination (MMSE) scoring was used for cognitive function assessment.

RESULTS AND CONCLUSION: (1) Cardiac indexes and mean arterial pressure in the four groups were significantly decreased before intubation compared with before anesthesia induction, while the heart rate increased significantly (P < 0.05). Compared with the other groups, the decreased amplitude in the cardiac index and mean arterial pressure were significantly lower in the group IV (P < 0.05), and the heart rate was also lower (P < 0.05) before intubation. There were no significant differences among the four groups during intubation, immediately after endotracheal intubation and 5 minutes after intubation. (2) The breathing recovery time, the time to open eyes on verbal command and extubation time were significantly shorter in the group IV than the other groups (P < 0.05), and restlessness and OAAS scores were also lower than the other groups (P < 0.05). (3) The MMSE score in each group was decreased after surgery compared with before anesthesia induction. Moreover, the MMSE score in the group IV was higher than that the other groups at 6 and 24 hours after surgery (P < 0.05). In conclusion, the results of this study indicate that the gradient effect-compartment target controlled infusion of propofol is preferred in the elderly patients, which has no influence on anesthesia effect, and can reduce the impact on the circulatory system and fasten recovery from anesthesia.

Key words: Propofol, Anesthetics, Intravenous, Hemodynamics, Anesthesia, Tissue Engineering

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