6%羟乙基淀粉130/0.4急性高容量血液稀释对喉罩置入成功时丙泊酚药效学的影响  

Effect of acute hypervolemic hemodilution with 6%hydroxyethyl starch 130/0.4 on pharmacodynamics of propofol during successful laryngeal mask airway implantation

作　　者：彭祝丁 吕婷敏 李集源 张杰斌 张奕文 陈汉文 Peng Zhuding;Lyu Tingmin;Li Jiyuan;Zhang Jiebin;Zhang Yiwen;Chen Hanwen(Department of Anesthesiology,Shunde Hospital of Southern Medical University(The First People′s Hospital of Shunde),Foshan 528300,China)

机构地区：[1]南方医科大学顺德医院(佛山市顺德区第一人民医院)麻醉科,528300

出　　处：《中华麻醉学杂志》2021年第11期1351-1355,共5页Chinese Journal of Anesthesiology

基　　金：佛山市自筹经费类科技计划项目(2020001004515);佛山市卫健局医学科研课题(20190332);佛山市"十三五"重点专科资助项目(FSZDZK135049);南方医科大学顺德医院临床研究育苗项目(CRSP2019011);佛山市杰出青年医学人才项目(600007)。

摘　　要：目的探讨6%羟乙基淀粉130/0.4急性高容量血液稀释(AHH)对喉罩置入成功时丙泊酚药效学的影响。方法选取拟全麻下行广泛全子宫切除术患者,年龄30~60岁,BMI 18.5~25.0 kg/m2,ASA分级Ⅰ或Ⅱ级,按随机数字表法分为AHH组(A组)和对照组(C组)。A组以20 ml/min速率静脉输注6%羟乙基淀粉130/0.4行AHH,目标Hct为30%,C组根据"4-2-1"法则输注乳酸林格液补充生理需要量,达目标并稳定10 min后行麻醉诱导。采用Bovil药代动力学模型TCI舒芬太尼,效应室浓度(Ce)0.25 ng/ml,3 min后采用Schnider模型TCI丙泊酚,设首例丙泊酚Ce为5.0μg/ml,按照序贯法,若喉罩置入失败则下一例患者升高一个浓度梯度,否则降低一个浓度梯度,相邻浓度梯度差为0.5μg/ml。当丙泊酚血浆浓度(Cp)和Ce达平衡1 min后,置入喉罩。连续出现8个喉罩置入失败/成功拐点时终止试验。采用Probit回归分析法计算喉罩置入成功时丙泊酚的EC_(5)、EC_(50)、EC_(95)及其95%可信区间(95%CI)。结果A组喉罩置入成功时丙泊酚的EC_(5)(95%CI)为4.237(3.090~4.514)μg/ml、EC_(50)(95%CI)为4.802(4.500~5.078)μg/ml、EC_(95)(95%CI)为5.443(5.125~7.304)μg/ml。C组喉罩置入成功时丙泊酚的EC_(5)(95%CI)为2.408(1.190~2.756)μg/ml、EC_(50)(95%CI)为3.120(2.690~3.472)μg/ml、EC_(95)(95%CI)为4.042(3.582~7.431)μg/ml。组间比较EC_(5)、EC_(50)和EC_(95)差异有统计学意义(P<0.01)。结论6%羟乙基淀粉130/0.4 AHH可降低丙泊酚诱导患者喉罩置入成功的效力。Objective To investigate the effect of acute hypervolemic hemodilution(AHH)with 6%hydroxyethyl starch 130/0.4 on pharmacodynamics of propofol during successful laryngeal mask airway(LMA)implantation.Methods American Society of Anesthesiology physical statusⅠorⅡpatients,aged 30-60 yr,with body mass index of 18.5-25.0 kg/m2,undergoing elective extensive total hysterectomy under general anesthesia,were divided into 2 groups:AHH group(group A)and control group(group C).In group A,6%hydroxyethyl starch 130/0.4 was infused at a rate of 20 ml/min for AHH,and the target hematocrit was 30%.In group C,lactated Ringer′s solution was infused according to the"4-2-1"rule to supplement physiological requirements,and anesthesia induction was performed after 10 min of stabilization.Sufentanil was administered by target-controlled infusion using Bovil pharmacokinetic model with effect-site concentration(Ce)of 0.25 ng/ml,3 min later propofol was given by target-controlled infusion using Schnider model.The Ce of propofol in the first patient was set at 5.0μg/ml.Each time the concentration of propofol was increased/decreased by 0.5μg/ml according to the sequential method.LMA was inserted following 1 min equilibration between plasma concentration and Ce of propofol.The trial was terminated when 8 consecutive inflection points of failed/successful LMA insertion occurred.The EC_(5),EC_(50),EC_(95) and 95%confidence interval(95%CI)of propofol were calculated by probit regression analysis.Results In group A,the EC_(5)(95%CI),EC_(50)(95%CI)and EC_(95)(95%CI)of propofol when LMA was successfully placed were 4.237(3.090-4.514)μg/ml,4.802(4.500-5.078)μg/ml and 5.443(5.125-7.304)μg/ml,respectively.In group C,the EC_(5)(95%CI),EC_(50)(95%CI)and EC_(95)(95%CI)of propofol when LMA was successfully placed were 2.408(1.190-2.756)μg/ml,3.120(2.690-3.472)μg/ml and 4.042(3.582-7.431)μg/ml,respectively.There was significant difference in EC_(5),EC_(50) and EC_(95) between the two groups(P<0.01).Conclusion AHH with 6%hydroxyethyl starch 13

关 键 词：羟乙基淀粉衍生物 血液稀释 二异丙酚 剂量效应关系 药物 喉面罩 

分 类 号：R614[医药卫生—麻醉学]