模拟航海刺激对患者丙泊酚麻醉敏感性的影响  

Effect of simulated ship motion on the anesthetic sensitivity of propofol in patients

作　　者：李建玉[1] 王勇 吴新文[1] 王治中[1] 刘晗[1] 刘思洋[1] 刘瑞琴[1] 

机构地区：[1]解放军第四二一医院麻醉科,广州510310 [2]解放军91561部队卫生队

出　　处：《中华航海医学与高气压医学杂志》2012年第4期207-212,共6页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

基　　金：全军医学科学技术研究“十一五”攻关课题（08c030）

摘　　要：目的探讨模拟航海刺激对患者丙泊酚麻醉敏感性的影响，为海上环境下丙泊酚的合理使用提供依据。方法采用旋椅试验制备运动病临床模型。75例患者均分为5组，每组15例。其中60例先分为非旋转组和旋转组，每组再分别采用丙泊酚单剂注射和丙泊酚单剂注射＋连续输注，形成2个麻醉组（只麻醉，不旋转）和2个研究组（先旋转，再麻醉）；另增1个对照组（只旋转，不麻醉）。麻醉敏感性测试包括两部分：（1）单次注射等量丙泊酚，观察麻醉组和研究组患者生命体征及熵指数等动态变化，并与对照组比较。（2）维持血流动力学稳定和状态熵（SE）为55％-60％，比较麻醉组和研究组患者所需丙泊酚输注速度及血药浓度。结果单剂注射丙泊酚，研究组反应熵（RE）和SE显著低于麻醉组，sE达到最低值所需时间研究组和麻醉组分别为（51．00±12．36）S和（67．50±14．72）s，研究组明显较短，2组比较差异有统计学意义（P〈0．01）。持续输注丙泊酚，维持sE在55％～60％范围30min时，研究组所需输注速度和血药浓度分别为（3．36±0．98）mg／（kg·h）和（2．95±0．79）μg/ml，麻醉组分别为（5．38±0．84）mg／（kg·h）和（4．41±0．87）μg/ml，研究组明显较低，2组比较差异有统计学意义（P〈0．01）；所需最低输注速度，研究组和麻醉组分别为2．00mg／（kg·h）和5．00mg／（kg·h），研究组明显较低，2组比较差异有统计学意义（P〈0．01）。对照组患者表现为较长时间的头晕，短时间的嗜睡，Ramsay镇静评分降低，最低SE和RE分别降至66％和52％。结论模拟航海刺激可明显增加患者对丙？白酚麻醉的敏感性，旋转刺激致大脑皮层受抑可能是其原因之一。Objective To explore the effect of simulated ship motion on the anesthetic sensitivity of propofol in patients, so as to provide evidence for rational application of propofol during deployment at sea. Methods The motion sickness model was developed by using the rotating-chair test. Seventy-five cases of motion sickness were randomly divided into 5 groups, each consisting of 15. Of the 75 cases, 60 were divided into the non-rotation and rotation groups. Then, each group was treated with a single injection of propofol and a single injection ＋ continuous infusion of propofol. Thereby, 2 anesthesia groups （with anesthesia only, but no rotation） and 2 experimental groups （with rotation first, then anesthesia） were formed. In addition, a control group （with rotation only, but without anesthesia） was established. The determination of anesthetic sensitivity consisted of 2 parts： （1）Dynamic changes in the vital signs and entropy indexes for the anesthesia and experimental groups were detected following injection of a single dose of propofol with the same dosage, and a comparison was made between them. （2）Hemodynamics and state entropy （SE） were maintained within 55% -60%, and then, infusion rate and serum concentration of propofol were compared between the anesthesia group and the experimental group. Results Following a single injection of propofol, SE and RE （ response entropy） for the experimental group were all obviously lower than those of the anesthesia group. The time for the experimental group and the anesthesia group to reach the minimal SE value were （51.00 ± 12.36）s and （67.50 ± 14.72）s respectively, with that of the experimental group obviously being shorter, and statistical significance could be noted, when a comparison was made between the two （ P 〈 0. 01 ）. For the experimental group, continuous infusion of propofol to maintain SE within 55% -60% for 30 min, an infusion rate of （3.36 ±0.98）mg/（kg · h） and a serum propofol concentration of （2.95 ±0.

关 键 词：模拟航海刺激 丙泊酚 熵指数 生命体征 旋椅试验 

分 类 号：R614[医药卫生—麻醉学]