急性等容血液稀释自体血体外隔离期间血浆中麻醉药物浓度变化及回输后对麻醉效应的影响  

Changes of anesthetic drug concentration in plasma during isolation of autologous blood with acute isovolumic hemodilution and its influence on anesthetic effect after reinfusion

作　　者：柳彤 徐佳明 王金伙 尹磊 陈永权[1] 郭建荣 LIU Tong;XU Jiaming;WANG Jinhuo;YIN Lei;CHEN Yongquan;GUO Jianrong(Department of Anesthesiology,Yijishan Hospital Affiliated to Wannan Medical College,Wuhu 241002,Anhui,China;Department of Anesthesia and Perioperative Medicine,Gongli Hospital,Naval Medical University,Shanghai 200135,China)

机构地区：[1]皖南医学院附属弋矶山医院麻醉科,安徽芜湖241002 [2]海军军医大学附属公利医院麻醉与围术期医学部,上海200135

出　　处：《中国临床药理学与治疗学》2023年第4期413-418,共6页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：上海市卫生健康委员会科研课题(202040474);上海市浦东新区卫生健康委员会卫生科技项目(PW2020A-17);上海市浦东新区卫生系统重点学科群建设项目(PWZxq2022-05)。

摘　　要：目的:探讨急性等容血液稀释(acute normovolemic hemodilution,ANH)自体血体外隔离期间血浆中麻醉药物浓度变化及回输后对麻醉深度、肌松效应和血药浓度的影响。方法:选择多节段脊柱手术患者40例,性别不限,年龄20~60岁,ASA分级Ⅰ或Ⅱ级,Hb≥120 g/L,Hct≥35%。采用随机数字表法将患者分为两组(n=20)。ANH组:麻醉诱导平稳后行ANH,目标Hct值28%~30%,主要手术操作步骤结束后回输自体血;对照组:常规输液输血处理。在麻醉诱导平稳(T1)、诱导平稳30 min(T2)、术毕(T3)、术毕30min(T4)、术毕1 h(T5)、术毕2 h(T6)观察并记录BIS和TOF值;采用液相色谱-串联质谱法(LC-MS/MS)检测T1~6时点和储存血1 h(TS1)、2 h(TS2)、回输前(TS3)血浆中丙泊酚、苯磺酸顺阿曲库铵的药物浓度。记录患者拔管时间以及T4~6时点苏醒评分。结果:两组丙泊酚血药浓度各时点组间比较无显著差异(P>0.05);ANH组苯磺酸顺阿曲库铵血药浓度在T3时较对照组高(P<0.05);采集血中两种麻醉药物浓度随时间延长略有降低,但各时点无统计学差异(P>0.05)。ANH组BIS值在T4时、TOF值在T3时明显低于对照组。ANH组苏醒评分在T4时低于对照组(P<0.05)。两组拔管时间无明显差异(P>0.05)。结论:ANH自体血体外隔离期间血浆中丙泊酚、苯磺酸顺阿曲库铵药物浓度基本不变,术中主要手术步骤结束后回输仅短暂地影响患者血浆苯磺酸顺阿曲库铵浓度,但未对术后的肌松恢复以及苏醒质量产生负面影响。AIM:To investigate the changes of anesthetic drug concentration in plasma during isolation of autologous blood with acute normovolemic hemodiluti-on and its influence on the depth of anesthesia,muscle relaxant effect and blood drug concentration after reinfusion.METHODS:Forty patients of both sexes,aged 20-60 yr,American Society of Anesthesiologists physical statusⅠorⅡ,hemoglobin(Hb)>120 g/L,hematocrit(Hct)>35%,undergoing eletive multilevel spinal surgery were included,were divided into 2 groups(n=20 each)using a random number table.ANH group(group A):ANH was performed after stable induction of anesthesia,the target Hct value was 28%-30%,and autologous blood was reinfused after the main operation steps.Control group(group C):routine transfusion and infusion treatment.The bispectral index(BIS)and Train-of-Four stimulation(TOF)were observed and recorded at the stable induction of anesthesia(T1),30 minutes of stable induction(T2),the end of operation(T3),30 minutes after the end of the operation(T4),1 hour after the end of the operation(T5)and 2 hours after the end of the operation(T6).The concentrations of propofol and cisatracurium besylate in plasma at T1-T6,stored blood at 1 h(TS1),2 h(TS2),and before reinfusion(TS3)were detected by Liquid Chromatographytandem Mass Spectrometry.The extubation time and recovery score at T4-6 hours were recorded.RESULTS:There was no significant difference in propofol between the two groups at each time point(P>0.05).The plasma concentration of cisatracurium besylate in group A was higher than that in group C at T3(P<0.05).The concentration of two kinds of anesthetic drugs in blood samples decreased slightly with time,but there was no significant difference between groups(P>0.05).The BIS value at T4 and TOF value at T3 in group A were significantly lower than those in group C.The recovery score of group A was lower than that of group C at T4(P<0.05).There was no significant difference in extubation time(P>0.05).CONCLUSION:The plasma concentrations of propofol and cisatracurium

关 键 词：急性等容血液稀释 麻醉深度 肌松效应 血药浓度 自体血回输 

分 类 号：R614[医药卫生—麻醉学]