阻塞性黄疸患者对吸入麻醉药的敏感性和血流动力学稳定性  

Anesthetic sensitivity and hemodynamic stability in patients with obstructive jaundice

作　　者：郑丽[1] 於章杰[1] 朱慧琛[1] 朱辉[1] 潘志英[1] 顾新宇[1] 杨立群[1] 

机构地区：[1]上海交通大学医学院附属仁济医院麻醉科,上海200127

出　　处：《上海医学》2015年第6期503-506,共4页Shanghai Medical Journal

摘　　要：目的比较行肝胆外科手术的高胆红素血症和胆红素正常患者对吸入麻醉药的敏感性，以及血流动力学稳定性。方法收集在异氟烷麻醉下行肝胆外科手术的阻塞性黄疸（黄疸组）和无阻塞性黄疸（对照组）患者各24例。静脉注射1．5～2mg／kg丙泊酚、2μg／kg瑞芬太尼行麻醉诱导，气管插管后控制异氟烷和氧气混合气体流量，维持脑电双频指数（BIS）为46~54。静脉注射麻黄碱、阿托品和瑞芬太尼维持血流动力学指标在基线水平上下30％以内波动。在气管插管前（T0）、麻醉诱导后1rain（T1）、气管插管后1和5min（T2、T3）、切皮后1和5min（T4、T5）、门静脉阻断后1和5min（T6、T7）、门静脉开放后1和5min（T8、T9）、拔除气管导管后1和5min（T10、T11）各时间点，记录患者的平均动脉压（MAP）、心率（HR），以及停用异氟烷至自主呼吸恢复的时间、拔除气管导管时间、对刺激睁眼反应的时间（睁眼时间）和呼气末异氟烷体积分数。结果两组间一般资料的差异均无统计学意义（P值均〉0．05）。黄疸组异氟烷每分钟消耗量、呼气末异氟烷体积分数、瑞芬太尼消耗量均显著低于对照组（P值均〈0．05），乳酸钠林格注射液、麻黄碱、阿托品用量均显著多于对照组（P值均〈O．05）。黄疸组恢复自主呼吸时间、拔除气管导管时间、睁眼时间均显著长于对照组（P值均〈0．05）。黄疸组在T2、T10、T11时间点的MAP均显著低于对照组同时间点（P值均〈0．05），在T4、T10时间点的HR均显著慢于对照组同时间点（P值均〈0．05）。结论阻塞性黄疸患者对异氟烷的敏感性增强，麻醉诱导和维持中更易出现低血压和心动过缓，且麻醉恢复时间和拔除气管导管时间延长。Objective To compare the sensitivity of volatile anesthetics and hemodynamic stability between patients with and without hyperbilirubinemia during hepatobiliary surgery. Methods Twenty-four patients with obstructive jaundice （jaundice group） and the same number of patients with normal liver function （control group） were scheduled for hepatobiliary surgery under isoflurane anesthesia and investigated in this study. Anesthesia was induced by intravenous injection of propofol （1.5 - 2 mg/kg） and remifentanil （2 μg/kg）. After tracheal intubation, anesthesia was titrated using isoflurane in oxygen enriched air and adjusted to maintain a bispectral index （BIS） of 46- 54. Ephedrine, atropine and remifentanil were used to maintain hemodynamic parameters within 30% of baseline. Mean arterial pressure （MAP） and heart rate （HR） were recorded at the following time points= before tracheal intubation （To）, 1 rain after anesthesia induction （T1）, 1 rain and 5 min after tracheal intubation （T2, T3）, 1 min and 5 min after skin incision （T4, T5）, 1 min and 5 min after blocking portal vein （T6, T7 ）, 1 min and 5 min after releasing portal vein （T8, T9 ）, 1 rain and 5 min after extubation （T10, T11 ）. The time of recovering from anesthesia, extubation, response to opening eye stimulation, and end expiratory volume fraction of isoflurane were also recorded. Results There was no significant difference in demographic data between two groups （all P〉0.05）. The consumption of remifentanil and end expiratory volume fraction of isoflurane in jaundice group were significantly less than those in control group （all P〈0.05）, while the use of ephedrine and atropine in jaundice group were significantly more than those in control group （P〈0.05）. The time of recovering from anesthesia, extubation, and response to opening eye stimulation in jaundice group were significantly longer than those in control group （all P〈0.05）. MAP in jaundice group was significantly lower th

关 键 词：阻塞性黄疸 异氟烷 敏感性 血流动力学效应 

分 类 号：R614[医药卫生—麻醉学]