BIS监测下肝移植手术中丙泊酚用量的变化  

Changes in dose requirements of propofol during liver transplantation

作　　者：池萍[1] 曹英浩[1] 郭晓东[1] 贺海丽[1] 彭科军[1] 权哲峰[1] 

机构地区：[1]首都医科大学附属北京佑安医院麻醉科,100069

出　　处：《临床麻醉学杂志》2011年第4期331-332,共2页Journal of Clinical Anesthesiology

摘　　要：目的以脑电双频指数（BIS）作为丙泊酚的药效学指标，观察肝移植手术三个分期丙泊酚用量的变化。方法行肝移植手术的患者22例，采用静一吸复合麻醉，维持BIS在35-50，观察无肝前期、无肝期、新肝期丙泊酚的用药量及尿量。结果无肝期和新肝期丙泊酚的输注量分别为（1．92±0．96）、（2．98±1．27）mg·kg^-1·h^-1，显著低于无肝前期的（4．40±1.42）mg·kg^-1·h^-1（P〈0．01）。无肝期尿量较无肝前期和新肝期显著减少（P〈0．01）。结论无肝期肝脏功能的完全缺如及移植新肝的功能状态是影响丙泊酚药效的主要因素，肾脏的排泄功能及血液稀释对丙泊酚的药效也有一定作用。Objective To observe changes in dose requirements of propofol during three phasas of liver transplantation by using bispectral index （BIS） as the pharmacodynamie index of propofol. Methods Twenty-two patients with liver cirrhosis undergoing liver transplantation were studied. BIS values were maintained between 35 to 50, and the dosage of propofol and urine output during three phases were recorded. Levels of hemoglobin （Hb）, serum albumin （ALB）, blood urea nitrogen （BUN）, serum creatinine （Cr） and creatinine clearance rate （CCr） were examined at preoperative, preanhepatic, anhepatie and neohepatic phases. Results Propofol dose requirements decreased significantly in anhepatic phase（1.92 ±0. 96）mg.kg^-1 .h^-1 and neohepatic phase（2. 98±1.27）mg.kg^-1 .h^-1 respectively, compared with that in preanhepatic phase （4. 40± 1.42） mg·kg^-1·h^-1 Urine output decreased significantly in anhepatic period（P 〈0. 01）. Hb was significantly lower at T1-T3 than at T0 （P〈0. 01）. Conclusion To maintain the same depth of anesthesia monitored by BIS during liver transplantation, there are 53. 9% and 31.6% decrease of propofol dose requirements in anhepatic and neohepatic phases compared with preanhepatic phase. The main factors that affect pharmacodynamic effects of propofol are the complete absence of hepatic function during anhepatic phase and the functional state of grafted new liver. Renal excretory function and hemodilution contribute to the efficacy of propofol to some extent.

关 键 词：肝移植 丙泊酚 脑电双频指数 

分 类 号：R614[医药卫生—麻醉学]