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作 者:曾海波[1] 马俊 袁世荧[1] 余汝林[3] 尚游[1]
机构地区:[1]华中科技大学同济医学院附属协和医院麻醉科,武汉市430022 [2]湖北省武汉市武昌医院麻醉科 [3]湖北省红安县人民医院麻醉科
出 处:《中华麻醉学杂志》2012年第1期57-59,共3页Chinese Journal of Anesthesiology
基 金:江苏省教育厅开放课题(KJS07004)
摘 要:目的通过比较日间与夜间靶控输注异丙酚的镇静效果,探讨近日节律对异丙酚镇静效果的影响。方法局部或臂丛神经阻滞下行急诊手部小手术的男性患者65例,ASA分级Ⅰ或Ⅱ级,年龄18~55岁,BMI18.5~24.9kg/m2,根据患者手术时间分为日间组(07:01至19:oo)和夜间组(19:01至07:00)。行臂丛或局部神经阻滞,确认麻醉效果完善后开始靶控输注异丙酚,靶控输注过程采用阶梯给药方式,设定4个目标效应室靶控浓度,依次为0.8、1.2、2.0和4.0μg/ml。当异丙酚效应室浓度达到预设值后,维持5min,记录该浓度下的BIS值。靶控输注过程中每分钟进行1次警觉镇静评分(OAA/S评分),并记录OAA/S评分为2分(患者意识消失)时的BIS值和异丙酚效应室浓度。结果共有58例患者完成研究,其中日间组28例,夜间组30例。与日间组比较,夜间组BIS基础状态、异丙酚效应室浓度1.2和2.0μg/ml时BIS值降低(P〈0.05),异丙酚效应室浓度0.8和4.0μg/ml时BIS值差异无统计学意义(P〉0.05),OAA/S2分时异丙酚效应室浓度降低(P〈0.05)而BIS值差异无统计学意义(P〉0.05)。结论近日节律可影响患者异丙酚的镇静效果,表现为夜间镇静效果强于日间。Objective To compare the hypnotic effect of propofol administered by target-controlled infusion (TCI) during day-time and night-time, in order to explore the effect of circadian rhythms on the sedative effect of propofol. Methods Sixty-five male ASA 1 or I1 patients aged 18-55 yr undergoing emergency minor hand surgery were divided into 2 gorups according to the time of the day when they received propofol TCI : day-time group (from 7:01 to 19:00) and night-time group (from 19:01 to 7:00). The pharmacokinetic parameters proposed by Schnider which predict effect-site concentration (Ce) were used. Four effect-site concentrations of propofol were set: 0.8, 1.2, 2.0 and 4.0 μg/ml. Ce was increased step by step and each Ce was maintained for 5 min. The level of sedation at each Ce was assessed by BIS and OAA/S scores. BIS value and Ce of propofol were recorded and compared between the 2 groups when the patients lost c9nsciousness (OAA/S score = 2). Results There was 28 and 30 patients in day-time and nigher-time groups respectively. When Ce = 1.2 and 2.0 μg/ml, the BIS values were significantly lower in night-time group than in day-time group. There was no significant difference in BIS value between the 2 groups when Ce = 0.8 and 4.0 μg/ml. When the patients lost consciousness (OAA/S = 2), the BIS value was comparable between the 2 groups, but Ce was significantly lower in night-time group than that in daytime group. Conclusion The hypnotic effect of propofol is greater during night-time than during day-time.
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