CAJ | 학술논문

目的观察不同血浆靶浓度的普鲁泊福对鼻内镜手术应激反应的影响.方法 60例ASA分级Ⅰ～Ⅱ级鼻内镜手术患者,按随机数字表法分为A、B、C三组,每组20例,普鲁泊福血浆靶浓度分别为3、4、5 μg/ml.记录麻醉前、手术开始后30min、拔管后60min的心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)、血糖、血清皮质醇及脑电双频指数(BIS)、气管拔管时间.结果手术开始后30minHR和MAP下降程度C组＞B组＞A组(P=0.024、0.010);拔管后60minMAP下降程度C组＞B组＞A组(P=0.011).A组BIS和气管拔管时间分别为65±8和(25±7)min,B组分别为53±11和(36±13)min,C组分别为45±12和(45±9)min,三组比较差异均有统计学意义(t=2.476,P=0.023;t=2.657,P=0.012).手术开始后30 min和拔管后60 min血糖均上升,上升程度A组＞B组＞C组(p=0.000、0.000);血清皮质醇在手术开始后30 min下降,下降程度C组＞B组＞A组(P=0.000),拔管后60min均上升,上升程度A组＞B组＞C组(P=0.001).结论利用靶控输注系统输注普鲁泊福,血药浓度设定在4～5μg/ml,可以保证适宜的麻醉深度,减少疼痛刺激,既能保持较为稳定的生命体征,又能比较有效地抑制鼻内镜手术操作刺激引起的应激反应,也能在较短的时间内去除气管导管,是较为合适的血浆靶浓度.
목적 관찰불동혈장파농도적보로박복대비내경수술응격반응적영향.방법 60례ASA분급Ⅰ～Ⅱ급비내경수술환자,안수궤수자표법분위A、B、C삼조,매조20례,보로박복혈장파농도분별위3、4、5 μg/ml.기록마취전、수술개시후30min、발관후60min적심솔(HR)、평균동맥압(MAP)、맥박혈양포화도(SpO2)、혈당、혈청피질순급뇌전쌍빈지수(BIS)、기관발관시간.결과 수술개시후30minHR화MAP하강정도C조＞B조＞A조(P=0.024、0.010);발관후60minMAP하강정도C조＞B조＞A조(P=0.011).A조BIS화기관발관시간분별위65±8화(25±7)min,B조분별위53±11화(36±13)min,C조분별위45±12화(45±9)min,삼조비교차이균유통계학의의(t=2.476,P=0.023;t=2.657,P=0.012).수술개시후30 min화발관후60 min혈당균상승,상승정도A조＞B조＞C조(p=0.000、0.000);혈청피질순재수술개시후30 min하강,하강정도C조＞B조＞A조(P=0.000),발관후60min균상승,상승정도A조＞B조＞C조(P=0.001).결론 이용파공수주계통수주보로박복,혈약농도설정재4～5μg/ml,가이보증괄의적마취심도,감소동통자격,기능보지교위은정적생명체정,우능비교유효지억제비내경수술조작자격인기적응격반응,야능재교단적시간내거제기관도관,시교위합괄적혈장파농도.
Objective To observe the effect of propofol target controlled infusion with different blood plasma target concentration on stress reaction during the nasal endoscope operation. Methods Sixty patients with ASA Ⅰ - Ⅱ scheduled for the nasal endoscope operation were divided into three groups by random digits table: each group was 20 patients, group A, B, C was given propofol target controlled infusion with blood plasma target concentration 3,4,5 μ g/mi respectively. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2), blood glucose, serum cortisol, bispectral index ( BIS ), extubation time were recorded before anesthesia,at 30 min after the operation starting and 60 min after the extubation.Results The descent degree of HR and MAP at 30 min after the operation starting were group C ＞ group B ＞ group A (P = 0.024,0.010 );the descent degree of MAP at 60 min after the extubation were group C ＞group B ＞ group A (P = 0.011 ). BIS and extubation time were 65 ± 8 and (25 ± 7) min in group A, 53 ± 11 and( 36 ± 13 ) min in group B, 45 ± 12 and(45 ± 9 ) min in group C, there were significant differences among three groups(t = 2.476,P= 0.023;t = 2.657,P= 0.012). The blood glucose was increased at 30 min after the operation starting and 60 min after the extubation, the ascensus degree were group A ＞ group B ＞ group C (P= 0.000、0.000);the serum cortisol was decreased at 30 min after the operation starting, the descent degree was group C ＞ group B ＞ group A (P= 0.000), increased at 60 min after the extubation, the ascensus degree was group A ＞ group B ＞ group C (P= 0.001 ). Conclusions Propofol target controlled infusion with blood plasma target concentration 4-5 μ g/ml can ensure eligible depth of anesthesia, decrease pain stimulus, remain stable vital sign,depress the stress reaction caused by nasal endoscope operation efficiently,with short extubation time. It is an eligible blood plasma target concentration.