病态肥胖患者采用去脂体重设定丙泊酚麻醉诱导剂量标准的研究  

作　　者：刘继明(译) 喻田(校) 

出　　处：《麻醉与镇痛》2012年第6期94-100,共7页Anesthesia & Analgesia

摘　　要：背景病态肥胖（morbidlyobese，MO）人群的麻醉风险有其特殊性，麻醉用药也因自身肥胖和体质差异而有所不同。然而，关于极度肥胖对麻醉药理影响的研究还相当有限。丙泊酚是病态肥胖患者最常用的麻醉诱导药物之一，然而针对病态肥胖人群，其最佳诱导剂量的计算方法尚存在争议。本研究针对MO人群基于体重计算丙泊酚诱导剂量的不同标量方法进行了比较。方法选取60例病态肥胖患者（体重指数≥40kg／m2），随机分组，分别根据总体重（totalbodyweight，TBW）或去脂体重（1eanbodyweight，LBW），接受麻醉诱导丙泊酚输注（100mg·kg-1·h-1）。对照组入选30例（体重指数≤25kg／m2），根据总体重确定丙泊酚输注量（100mg·kg-1·h-1）。患者手中注射器掉落作为意识丧失（10ssofconsciousness，LOC）的标记，此时停止输注丙泊酚。记录意识丧失时间和丙泊酚的输注量。结果在对照组与去脂体重为标准输注丙泊酚的病态肥胖组，意识丧失时间和丙泊酚的输注量差异无统计学意义。以总体重为标准输注丙泊酚的病态肥胖组，丙泊酚输注剂量显著增加且LOC的时间明显缩短。3组患者去脂体重与丙泊酚输注量之间均存在密切相关。结论去脂体重更适合作为确定MO患者全身麻醉丙泊酚诱导剂量的体重参数。BACKGROUND： The unique anesthetic risks associated with the morbidly obese （MO） population have been documented. Pharmacologic management of these patients may be altered because of the physiologic and anthropometric changes associated with obesity. Unfortunately, studies examining the effects of extreme obesity on the pharmacology of anesthetics have been sparse. Although propofol is the induction drug most frequently used in these patients, the appropriate induction dosing scalar for propofol remains controversial in MO subjects. Therefore, we compared different weight-based scalars for dosing propofol for anesthetic induction in MO subjects. METHODS： Sixty MO subjects （body mass index≥40 kg/m2） were randomized to receive a propofol infusion （100 mg · kg-1 · h-1） for induction of anesthesia based on total body weight （TBW） or lean body weight （LBW）. Thirty control subjects （body mass index ≤25 kg/ m2） received a propofol infusion （100 mg · kg-1· h -1） based on TBW. Syringe drop was used as the marker for loss of consciousness （LOC）, at which point the propofol infusion was stopped. The propofol dose required for syringe drop and time to LOC were recorded. RESULTS： Total propofol dose （mg/kg） required for syringe drop and time to LOC were similar between control subjects and MO subjects given propofol based on LBW. MO subjects receiving a propofol infusion based on TBW had a significantly larger propofol dose and significantly shorter time to LOC. There was a strong relationship between LBW and total propofol dose received in all 3 groups. CONCLUSIONS： LBW is a more appropriate weight-based scalar for propofol infusion for induction of general anesthesia in MO subjects.

关 键 词：麻醉诱导药物 体重指数 肥胖患者 病态肥胖 剂量标准 丙泊酚 去脂 输注剂量 

分 类 号：R614[医药卫生—麻醉学]