CAJ | 학술논문

目的：观察外科手术中肝功能不同患者靶控输注丙泊酚的药效反应。方法本前瞻性研究对象为2013年6月至2014年6月在中山大学附属第三医院接受气管插管全身麻醉下开腹手术的60例患者。其中男51例，女9例；年龄18～70岁，中位年龄48岁。所有患者均签署知情同意书，符合医学伦理学规定。根据肝功能Child-Pugh分级将患者分为4组：肝功能正常组（N组）7例，肝功能分级A级组（A组）21例，B级组（B组）20例，C级组（C组）12例。术中所有患者采用靶控输注丙泊酚，目标血药浓度3μg/ml。记录4组患者在麻醉诱导期（靶控输注30 min内）脑电双频指数（BIS）值及血流动力学指标，比较各组BIS下降至40以下患者的百分率及血流动力学事件发生率。率的比较采用χ2检验或Fisher确切概率法。结果麻醉诱导期，4组患者的BIS随时间逐渐下降，20 min时基本稳定。N、A、B、C组BIS下降至40以下的百分率分别为9.2%、11.2%、20.4%、26.8%，C组明显高于N组和A组（χ2=12.28，18.81；P<0.05）。麻醉诱导期，N、A、B、C组低血压发生频率分别为0、5%、8%、16%，C组明显高于N、A、B组（P<0.0001，P<0.0001，P=0.0195）。N、A、B、C组心动过缓发生频率分别为15%、5%、3%、0，C组明显低于N、A、B组（P<0.0001，P=0.0003，P=0.0085）。结论采用丙泊酚靶控输注麻醉诱导时，肝功能不同患者麻醉深度呈现相似的变化趋势，但重度肝功能不全患者更易出现脑电波暴发性抑制和低血压。
목적：관찰외과수술중간공능불동환자파공수주병박분적약효반응。방법본전첨성연구대상위2013년6월지2014년6월재중산대학부속제삼의원접수기관삽관전신마취하개복수술적60례환자。기중남51례，녀9례；년령18～70세，중위년령48세。소유환자균첨서지정동의서，부합의학윤리학규정。근거간공능Child-Pugh분급장환자분위4조：간공능정상조（N조）7례，간공능분급A급조（A조）21례，B급조（B조）20례，C급조（C조）12례。술중소유환자채용파공수주병박분，목표혈약농도3μg/ml。기록4조환자재마취유도기（파공수주30 min내）뇌전쌍빈지수（BIS）치급혈류동역학지표，비교각조BIS하강지40이하환자적백분솔급혈류동역학사건발생솔。솔적비교채용χ2검험혹Fisher학절개솔법。결과마취유도기，4조환자적BIS수시간축점하강，20 min시기본은정。N、A、B、C조BIS하강지40이하적백분솔분별위9.2%、11.2%、20.4%、26.8%，C조명현고우N조화A조（χ2=12.28，18.81；P<0.05）。마취유도기，N、A、B、C조저혈압발생빈솔분별위0、5%、8%、16%，C조명현고우N、A、B조（P<0.0001，P<0.0001，P=0.0195）。N、A、B、C조심동과완발생빈솔분별위15%、5%、3%、0，C조명현저우N、A、B조（P<0.0001，P=0.0003，P=0.0085）。결론채용병박분파공수주마취유도시，간공능불동환자마취심도정현상사적변화추세，단중도간공능불전환자경역출현뇌전파폭발성억제화저혈압。
ObjectiveTo observe the pharmacodynamic effect of propofol by target controlled infusion (TCI) in patients with different liver functions during surgery.MethodsSixty patients undergoing laparotomy under general anesthesia with endotracheal intubation in the Third Affiliated Hospital of Sun Yat-sen University between June 2013 and June 2014 were enrolled in this prospective study. Among the 60 patients, 51 were males and 9 were females with the age ranging from 18 to 70 years old and the median of 48 years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients were divided into 4 groups according to the Child-Pugh liver function grading, the normal liver function group (N group,n=7), grade A group (A group, n=21), grade B group (B group,n=20) and grade C group (C group,n=12). TCI propofol were given to all patients during the operation with the target plasma concentration of 3 μg/ml. Bispectral index (BIS) and hemodynamic parameters of the 4 groups during the anesthesia induction period (within 30 min of TCI) were recorded. The percentage of patients with BIS dropped below 40 and the incidence of hemodynamic events in each group were compared. The comparison was conducted using Chi-square test or Fisher's exact test.ResultsDuring the anesthesia induction period, BIS of the 4 groups dropped with time and was stable at 20 min. The percentage of patients with BIS below 40 in N, A, B and C group was respectively 9.2%, 11.2%, 20.4% and 26.8%, C group was signiifcantly higher than N and A group (χ2=12.28, 18.81;P<0.05). During the anesthesia induction period, the incidence of hypotension in N, A, B and C group was respectively 0, 5%, 8% and 16%, C group was signiifcantly higher than N, A and B group (P<0.0001, P<0.0001,P=0.0195). The incidence of bradycardia in N, A, B and C group was respectively 15%, 5%, 3% and 0, C group was significantly lower than N, A and B group (P<0.0001,P=0.0003,P=0.0085). ConclusionsSimilar trends of change in anesthesia depth are observed in patients with different liver function when using propofol TCI, but patients with severe hepatic dysfunction may more likely to develop fulminant suppression of brain wave and hypotension.