术中静脉输注不同剂量异丙酚对患者酸碱平衡及脂质代谢的影响  

Effects of infusion of different doses of propofol during operation on acid-base balance and lipid metabolism

作　　者：秦榜勇[1] 冯树南[1] 朱昭琼[1] 蔡回钧[1] 向家林[2] 

机构地区：[1]遵义医学院附属医院麻醉科,563003 [2]遵义医学院附属医院检验科,563003

出　　处：《中华麻醉学杂志》2009年第11期968-971,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价术中静脉输洼不同剂量异丙酚对患者酸碱平衡及脂质代谢的影响。方法拟行广泛全子宫加盆腔淋巴结清扫术的宫颈癌患者60例，年龄30～64岁，体重40～75kg，ASAⅠ或Ⅱ级，随机分为3组（n=20），Ⅰ组、Ⅱ组和Ⅲ组分别静脉输注异丙酚50、100、150ug·kg^-1·min^-1。分别于麻醉诱导前即刻、开始静脉输注后1、2、3h及术毕时行动脉血气分析，记录pH值、总二氧化碳（TCO2）、碱剩余（BE）、HCO3^-及乳酸（LA）浓度；取颈内静脉血样2ml测定血清甘油三脂（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白A1（APOA1）及载脂蛋白B（APOB）的浓度。结果3组各指标均在正常范围内。与麻醉诱导前即刻比较，静脉输注异丙酚后3组pH值、TCO3、BE、HCO3^-及APOA，浓度降低，LA及TG浓度升高，Ⅱ组及Ⅲ组LDL-C浓度降低，Ⅲ组APOB浓度降低（P〈0．05或0．01）；与Ⅰ组比较，静脉输注异丙酚后Ⅱ组及Ⅲ组pH值、BE、LDL—C及APOB浓度降低，TG浓度升高，Ⅲ组TCO2、HCO3^-、TC及APOA．浓度降低（P〈0．05或0．01）；与Ⅱ组比较，静脉输注异丙酚后Ⅲ组pH值、TCO2、BE、TC及APOB浓度降低，TG浓度升高（P〈0．05或0．01）。结论短时静脉输注异丙酚时患者酸碱平衡及脂质代谢均在正常范围，但有发生代谢性酸中毒及脂质代谢异常的趋势，且与剂量有关。Objective To investigate the effects of infusion of different doses of propofol during operation on acid-base balance and lipid metabolism. Methods Sixty ASA Ⅰ or Ⅱ patients with cervical cancer, aged 30- 64 yr, weighing 40-75 kg, scheduled for radical hysterectomy and pelvic lymph node dissection, were randomly divided into 3 groups （ n = 20 each） ： group Ⅰ, Ⅱ and Ⅲ received infusion of propofol at the rate of 50, 100 and 150ug·kg·^-1min^-1 to maintain anesthesia, respectively. Blood samples were taken from radial artery immediately before anesthesia induction （Tj）, at 1, 2 and 3 h after the start of propofoi infusion （T2-4 ） and at the end of operation （T5 ） for blood gas analysis, and pH value, HCO3^-, total carbon dioxide （TCO2）, base excess （ BE ） and lactic acid （LA） concentrations were recorded. Blood samples were taken from internal jugular vein for determination of serum concentrations of triglyeride （TG）, total cholesterol （TC）, high density lipoprotein cholesterol （HDL-C）, low density lipoprotein cholesterol （LDL-C）, apolipoprotein A1 （APOA1） and apolipoproteiri B （APOB） .Results All the parameters in the 3 groups were in the normal ranges. Compared with those at T1 , the pH value and concentrations of TCO2, BE, HCO3^- and APOA1 were significantly decreased, while LA and TG concentrations were signifcantly increased after propofol infusion in all the groups, and LDL-C concentrations in group Ⅱ and Ⅲ and APOB concentration in group Ⅲ were significantly decreased after propofol infusion （ P 〈 0.05 or 0.01）. Compared with group Ⅰ , the pH value and concentrations of BE, LDL-C and APOB were significantly decreased, while TG concentration was significantly increased after propofol infusion in group Ⅱ and Ⅲ , and concentrations of TC02, HC03 , TC and APOAt were significantly decreased after propofol infusion in group Ⅲ （P 〈 0.05 or 0.01）. The pH value and concentrations of TCO2, BE, TC and APOB were significantly low

关 键 词：二异丙酚 酸碱平衡失调 脂代谢障碍 

分 类 号：R614[医药卫生—麻醉学]