CAJ | 학술논문

目的通过比较日间与夜间靶控输注异丙酚的镇静效果,探讨近日节律对异丙酚镇静效果的影响.方法局部或臂丛神经阻滞下行急诊手部小手术的男性患者65例,ASA分级Ⅰ或Ⅱ级,年龄18～55岁,BMI 18.5～ 24.9 kg/m2,根据患者手术时间分为日间组(07:01至19:00)和夜间组(19:01至07:00).行臂丛或局部神经阻滞,确认麻醉效果完善后开始靶控输注异丙酚,靶控输注过程采用阶梯给药方式,设定4个目标效应室靶控浓度,依次为0.8、1.2、2.0和4.0 μg/ml.当异丙酚效应室浓度达到预设值后,维持5 min,记录该浓度下的BIS值.靶控输注过程中每分钟进行1次警觉镇静评分(OAA/S评分),并记录OAA/S评分为2分(患者意识消失)时的BIS值和异丙酚效应室浓度.结果共有58例患者完成研究,其中日间组28例,夜间组30例.与日间组比较,夜间组BIS基础状态、异丙酚效应室浓度1.2和2.0 μg/ml时BIS值降低(P＜0.05),异丙酚效应室浓度0.8和4.0 μg/ml时BIS值差异无统计学意义(P＞0.05),OAA/S 2分时异丙酚效应室浓度降低(P＜0.05)而BIS值差异无统计学意义(P＞0.05).结论近日节律可影响患者异丙酚的镇静效果,表现为夜间镇静效果强于日间.
목적 통과비교일간여야간파공수주이병분적진정효과,탐토근일절률대이병분진정효과적영향.방법 국부혹비총신경조체하행급진수부소수술적남성환자65례,ASA분급Ⅰ혹Ⅱ급,년령18～55세,BMI 18.5～ 24.9 kg/m2,근거환자수술시간분위일간조(07:01지19:00)화야간조(19:01지07:00).행비총혹국부신경조체,학인마취효과완선후개시파공수주이병분,파공수주과정채용계제급약방식,설정4개목표효응실파공농도,의차위0.8、1.2、2.0화4.0 μg/ml.당이병분효응실농도체도예설치후,유지5 min,기록해농도하적BIS치.파공수주과정중매분종진행1차경각진정평분(OAA/S평분),병기록OAA/S평분위2분(환자의식소실)시적BIS치화이병분효응실농도.결과 공유58례환자완성연구,기중일간조28례,야간조30례.여일간조비교,야간조BIS기출상태、이병분효응실농도1.2화2.0 μg/ml시BIS치강저(P＜0.05),이병분효응실농도0.8화4.0 μg/ml시BIS치차이무통계학의의(P＞0.05),OAA/S 2분시이병분효응실농도강저(P＜0.05)이BIS치차이무통계학의의(P＞0.05).결론 근일절률가영향환자이병분적진정효과,표현위야간진정효과강우일간.
Objective To compare the hypnotic effect of propofol administered by target-controlled infusion (TCI) during day-time and night-time,in order to explore the effect of circadian rhythms on the sedative effect of propofol.Methods Sixty-five male ASA Ⅰ or Ⅱ patients aged 18-55 yr undergoing emergency minor hand surgery were divided into 2 gorups according to the time of the day when they received propofol TCI:day-time group (from 7:01 to 19:00) and night-time group (from 19:01 to 7:00).The pharmacokinetic parameters proposed by Schnider which predict effect-site concentration (Ce) were used.Four effect-site concentrations of propofol were set:0.8,1.2,2.0 and 4.0 μg/ml.Ce was increased step by step and each Ce was maintained for 5 min.The level of sedation at each Ce was assessed by BIS and OAA/S scores.BIS value and Ce of propofol were recorded and compared between the 2 groups when the patients lost consciousness (OAA/S score =2).Results There was 28 and 30 patients in day-time and nighet-time groups respectively.When Ce =1.2 and 2.0 μg/ml,the BIS values were significantly lower in night-time group than in day-time group.There was no significant difference in BIS value between the 2 groups when Ce =0.8 and 4.0 μg/ml.When the patients lost consciousness (OAA/S =2),the BIS value was comparable between the 2 groups,but Ce was significantly lower in night-time group than that in daytime group.Conclusion The hypnotic effect of propofol is greater during night-time than during day-time.