靶控输注时丙泊酚镇静效力的影响因素  

Factors influencing the sedative effect of propofol during target controlled infusion

作　　者：王怡鸾[1] 南洋[1] 王倩[1] 李军[1] WANG Yiluan;NAN Yang;WANG Qian;LI Jun(Department of Anesthesiology and Perioperative Medicine,the Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University,Wenzhou 325027,China)

机构地区：[1]温州医科大学附属第二医院育英儿童医院麻醉与围术期医学科,浙江温州325027

出　　处：《温州医科大学学报》2019年第6期427-431,共5页Journal of Wenzhou Medical University

基　　金：浙江省基础公益研究计划项目(LY18H010005)

摘　　要：目的:分析靶控输注时影响丙泊酚镇静效力的相关因素。方法:选择2018年3月至2018年6月在温州医科大学附属第二医院育英儿童医院择期手术行全身麻醉的100例患者,记录所有患者的年龄、性别、身高、体质量和BMI、收缩压、舒张压及各项血液生化指标,采用靶控输注丙泊酚,初始血浆靶浓度设置为1.2 μg/m L,达到血浆靶浓度30 s后,按照梯度每30 s增加0.3 μg/m L直至患者意识消失,记录此时丙泊酚的血浆靶浓度。采用Spearman秩相关和秩和检验分析各变量与血浆靶浓度的相关性,将筛选出的变量纳入逐步多元线性回归模型,最终确定影响丙泊酚镇静效力的独立影响因素。采用LOESS模型对获得的独立影响因素同血浆靶浓度进行分析,拟合趋势图。结果:相关性分析显示年龄、BMI、收缩压、血糖、尿素氮、尿素氮/肌酐及高血压史与血浆靶浓度显著相关(P<0.05),逐步多元线性回归分析显示年龄、BMI和收缩压是丙泊酚镇静效力的独立影响因素(P<0.05)。根据LOESS模型拟合后的趋势图显示随着年龄和BMI的增加,所需血浆靶浓度呈下降趋势;而随着收缩压的升高所需血浆靶浓度则是先升高后下降。结论:靶控输注时年龄、BMI和收缩压是影响丙泊酚镇静效力的显著因素。Objective: To analyze the relevant factors affecting the sedative efficacy of propofol in targetcontrolled infusion. Methods: A total of 100 patients scheduled for elective operation undergoing general anesthesia from March to June 2018 in the Second Affiliated Hospital of Wenzhou Medical University were included in this study. Age, gender, height, weight and body mass index (BMI), systolic blood pressure, diastolic blood pressure and blood biochemical indexes of the patients were recorded. Patients were received propofol in targetcontrolled infusion, and the initial plasma target concentration was set at 1.2 μg/mL. After the target concentration was steadily maintained for 30 s, the gradient was increased by 0.3 μg/mL every 30 s until the patients lost consciousness. The target plasma concentration of propofol at this time was recorded. Spearman rank correlation and rank sum test were used to analyze the correlation between each variable and the plasma target concentration, and the screened variables were included in the stepwise multiple linear regression model, finally determining the independent influencing factors. LOESS model was used to analyze the association between independent influencing factors and plasma target concentration, then the trend chart was fitted. Results: Correlation analysis showed that age, BMI, systolic blood pressure, blood glucose, urea nitrogen, urea nitrogen/creatinine and history of hypertension were significantly associated with the target plasma concentration (P<0.05). Stepwise multiple linear regression analysis showed that age, BMI, and systolic blood pressure were independent factors in the efficacy of propofol sedation (P<0.05). According to the trend chart fitted by LOESS model, the plasma target concentration decreased as the increase of age and BMI. The plasma target concentration was first increased and then decreased as the increase of systolic blood pressure. Conclusion: Age, BMI and systolic blood pressure are significant factors affecting the efficacy of propofol s

关 键 词：靶控输注 丙泊酚 血浆靶浓度 镇静 

分 类 号：R614[医药卫生—麻醉学]