丙泊酚对肝硬化患者全麻中镇静效应的影响  

Effects of hepatic cirrhosis sedative in patients on propofol anesthesia

作　　者：徐晨[1] 任波[1] 张云辉[1] 毕振华[1] 金晓菲[1] 刘霞[1] 马苗[1] 李军[1] 董刚[1] 

机构地区：[1]解放军第302医院麻醉科,北京市100039

出　　处：《临床麻醉学杂志》2013年第11期1048-1050,共3页Journal of Clinical Anesthesiology

摘　　要：目的探讨丙泊酚对肝硬化患者全麻中镇静效应的影响。方法选取三组患者:肝硬化且肝功能A级患者32例(A组),肝硬化且肝功能B级患者26例(B组),非肝硬化、肝功能正常,接受其他手术的患者25例作为对照组(C组),比较三组患者在丙泊酚全麻诱导中意识消失、BIS值为50时的丙泊酚靶浓度、效应室浓度及丙泊酚用量。结果术前A、B组血浆白蛋白含量明显低于C组(P<0.05),术后B组血浆白蛋白含量明显低于C组(P<0.05);术前B组胆红素含量明显低于C组(P<0.05)。B组患者意识消失时和BIS 50时的效应室浓度和丙泊酚用量分别为(1.46±0.47)μg/ml、(1.93±0.56)μg/ml和(0.12±0.03)ml/kg、(0.16±0.04)ml/kg,明显低于C组的(2.02±0.65)μg/ml、(2.9±1.31)μg/ml和(0.15±0.02)ml/kg、(0.19±0.05)ml/kg。结论丙泊酚在肝硬化患者全麻诱导中的用量明显低于肝功能正常者,且肝功能越差,丙泊酚用量越少。Objective To investigate the effects of hepatic function on propofol dosage and depth of anesthesia in cirrhotic patients receiving general anesthesia. Methods Patients were divided into three groups according to hepatic function.. Child＇s class A cirrhosis（group A, n= 32）, Child＇s class B cirrhosis（group B, n=26）and normal hepatic function（group C, n=25）. The time to lost of consciousness （LOC） after propofol induction, the target concentration and calculated effect site concentrations （Ce） of propofol and total dosages of propofol used at a bispectral index （BIS） level of 50 were recorded and compared in the three groups. Results Serum albumin levels were significantly lower in groups A and B compared to group C pre-operatively （P〈0.05）. After surgery, the serum albumin levels and bilirubin levels were significantly lower in patients in group B than those in group C （P〈0.05）. At the time of LOC or BIS 50 （BIS values were 50）, Ce of propofol were （1.46±0.47） μg/ml and（1.93±0.56）μg/ml respectively, and the amount of propofol used were （0. 12 ± 0.03） ml/kg and（0.16±0.04）ml/kg respectively in group B, all of which are significantly lower than the corresponding values in group C [（2.02±0.65） μg/ml, （2.9±1.31） μg/ml, （0. 15±0.02） ml/kg and （0.19±0.05） ml/kg] respectively （P〈0. 05）. Conclusion Hepatic cirrhosis is associated with a reduction in propofol dosage during TCI induction. The worse the hepatic function is, the less propofol is needed.

关 键 词：全身麻醉 丙泊酚 肝硬化 BIS值 

分 类 号：R614[医药卫生—麻醉学]