不同程度的慢性病毒相关肝病患者肝移植术中丙泊酚⁃瑞芬太尼联合七氟醚麻醉的用量分析  

Analysis on the anesthetic amounts of propofol remifentanil combined with sevoflurane used in the patients with chronic virus⁃related liver disease in liver transplantation

作　　者：刘婷婷[1] 陈静 解东明 邓友明 Liu Tingting;Chen Jing;Xie Dongming;Deng Youming(Department of Anesthesia,Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine(Nanjing Second Hospital),Nanjing 210003,China)

机构地区：[1]南京中医药大学附属南京医院(南京市第二医院)麻醉科,江苏南京210003 [2]东部战区总医院秦淮医疗区(原解放军第八一医院)麻醉科

出　　处：《海军医学杂志》2023年第6期607-612,共6页Journal of Navy Medicine

摘　　要：目的探究慢性病毒相关肝病的严重程度对丙泊酚⁃瑞芬太尼联合七氟醚麻醉期间麻醉药物需用量的影响。方法临床招募2019年5月至2021年11月在东部战区总医院秦淮医疗区(原解放军第八一医院)因慢性乙型肝炎病毒感染而计划进行肝移植的100例患者作为研究对象。根据Child⁃Turcotte⁃Pugh(CTP)分类,将患者分为轻度组(n=28)、中度组(n=39)和重度组(n=33)。比较各组患者一般资料。记录各组患者达到既定脑电双频指数(BIS)范围时的丙泊酚需求量。比较分析轻度组、中度组和重度组患者的基线脑电双谱指数(BIS)值、拔管前BIS值和手术期间平均BIS值。观察患者对初始手术皮肤切口的运动反应,确定七氟醚的最低肺泡有效浓度(MAC)。切口后1 min监测记录各组患者的心率和平均动脉压。结果3组患者诱导浓度、插管前浓度、切口前浓度比较差异有统计学意义(P<0.05),且轻度组诱导浓度显著高于重度组(P<0.05),插管前浓度、切口前浓度比较,轻度组>中度组>重度组(P<0.05)。3组患者拔管前BIS值和手术期间平均BIS值比较差异无统计学意义(P>0.05)。插管前轻度组、中度组和重度组患者BIS值低于基线BIS值,差异有统计学意义(P<0.05),手术期间的平均BIS值最低,与基线BIS比较差异有统计学意义(P<0.05)。在皮肤切开前,重度组患者的七氟醚呼气末浓度稳定保持18 min,轻度组和中度组保持24 min,重度组患者七氟醚挥发性麻醉剂的需求量低于中度组和轻度组(P<0.05)。重度组患者MAC低于中度组和轻度组(P<0.05)。各组患者心率和平均动脉压比较差异无统计学意义(P>0.05)。多因素变量分析表明,肝功能不全(疾病严重程度评分)是影响丙泊酚和七氟醚浓度降低的危险因素(P<0.05)。结论肝功能不全最严重的患者需要使用最低浓度的丙泊酚和七氟醚。Objective To explore the effects of the severity of chronic virus⁃associated liver disease on the anesthetic amounts used in the patients during anaesthesia with propofol remifentanil combined with sevoflurane anesthesia.Methods A total of 100 patients who expected to undergo liver transplantation due to chronic hepatitis B virus infection in the hospital from May 2019 to November 2021 were recruited as study subjects.According to the severity of liver disease evaluated by Child⁃Turcotte⁃Pugh(CTP),the patients were divided into the mild group(n=28),the moderate group(n=39)and the severe group(n=33).General medical data of the patients were compared between the groups.The amounts of propofol required when the patients in each group reached the established bispectral index(BIS)dosages were recorded closely.The baseline BIS value,the BIS value before extubation and the average BIS value during surgery in the mild,moderate and severe groups were compared and analyzed between the 3 groups.Minimum alveolar concentration(MAC)of sevoflurane was determined by observing the patient's motion response to the initial surgical skin incision.The heart rates and mean arterial pressures of the patients in each group were monitored and recorded 1 minute after incision.Results There was statistical significance in induction concentration,pre⁃intubation concentration and pre⁃incision concentration,when comparisons were made between the three groups(P<0.05),with the inducing concentration of the mild group being significantly higher than that of the severe group(P<0.05).The results showed that the pre⁃intubation concentration and pre⁃incision concentration of the mild group was greater than that of the moderate group,and that of the moderate group was greater than that of the severe group(P<0.05).There was no statistical significance in the BIS value before extubation and the average BIS value during surgery(P>0.05).The BIS value before intubation in the mild group,the moderate group and the severe group all dropped as

关 键 词：慢性病毒相关肝病 肝移植 丙泊酚 七氟醚 

分 类 号：R614[医药卫生—麻醉学]