摘要
目的探讨月经周期对异丙酚麻醉半数有效剂量的影响及机制。方法选择2012年1月~2014年12月间在我院行腹腔镜手术的72例妇产科患者,根据其血清孕酮水平的不同分为卵泡期组和黄体期组,每组36例。以目标靶浓度控制输注（TCI）技术经静脉靶控输注异丙酚实施麻醉诱导,起始血浆浓度设为2.0 mg/L,达到预期血浆靶浓度后每30秒递增0.5 mg/L,直至患者意识消失,药代动力学模型采用Marsh模型。记录意识消失时（T1）、BIS降至50时（T2）、患者苏醒时（T3）三个时间点的BIS、平均动脉压（MAP）、心率（HR）、异丙酚血药浓度以及半数有效剂量（ED50）,并测定其激素水平。结果两组患者在各时间点MAP、HR及BIS值的差异均无统计学意义（P〉0.05）,黄体期组患者的异丙酚血浆浓度在T1、T2两个时间点均低于卵泡期组,差异有统计学意义（P〈0.05）,黄体期组BIS达到50时异丙酚所需的诱导用量较卵泡期组少（P〈0.05）;两组间苏醒浓度无明显差异（P〉0.05）,而与卵泡期组苏醒时间相比,黄体期组患者苏醒时间明显缩短（P〈0.05）。结论月经周期可影响异丙酚的镇静效应,全麻诱导时黄体期患者的异丙酚半数有效剂量明显减少,苏醒时间缩短,可能与孕酮水平有关。
Objective To explore the effects and mechanism of menstrual cycle for median effective dose of propofol anesthesia. Methods The clinical data of 72 patients undergoing gynaeeological laparoscopy in the hospital during Jan 2012 to Dec 2014 were divided into follicular group and luteal group according to different serum progesterone level, each group had 36 patients. Anesthesia was first induced with target controlled infusion system of propofol using Marsh pharmacokinetic model at an initial target plasma concentration of 2.0 mg/L followed by increments of 0.5 mg/L per 30 s until loss of consciousness. BIS, MAP,HR,plasma concentration of propofol, and the total induction dose of propofol were recorded at T1 （loss of eyelash reflex）,T2（the value of BIS below 50）and T3（reeovery of anesthesia）. At the same time hormone levels were determined. Results There was no statistical diference in MAP, HR, and BIS at each time point （P〉0.05）.In the luteal group,the total induction dose of propofol when BIS reduced to 50 were significantly lower than those in the follicular group（P〈0.05）. There was no obvious difference in awakening concentration between the two groups（P〉0.05）. The emergence time of the patients in luteal group was significantly shorter than that in follicular group（P〈0.05）. Conclusion Menstrual cycle can affect the sedative effect of propofol in patients.The ED50 of propofol for general anesthesia induction is reduced significantly in luteal group, the emergence time is significantly shorter, may be affected by the levels of progesterone.
出处
《中国现代医生》
2015年第22期12-15,共4页
China Modern Doctor
基金
浙江省医药卫生科技计划(2013KYA102)
关键词
月经周期
异丙酚
麻醉半数有效剂量
Menstrual cycle
Propofol
Median effective of anesthesia
