腹腔镜手术中根据吸入呼出气浓度测算异氟醚血药浓度的方法研究

Method for calculating the blood concentration of isoflurane with the inspired and expired concentrations during laparoscopic surgery

目的:腹腔镜手术中根据吸入呼出气浓度测算异氟醚血药浓度。方法:该试验共分2部分:选择23例ASAⅠ～Ⅱ级全身麻醉下行腹部手术的患者,其中腹腔镜手术12例,非腹腔镜手术11例,分别于吸入异氟醚20、40、60和80min后抽取中心静脉血,用气相色谱仪测定异氟醚血药浓度,通过自行改进公式得到不同的异氟醚的摄取分数。另选27例全身麻醉下行腹部手术的患者,其中腹腔镜手术13例,非腹腔镜手术14例,处理过程同上,将上述异氟醚的摄取分数代入自行改进公式后观察实测血药浓度与公式计算浓度之间的关系。结果:腹腔镜手术中F值为0.52,非腹腔镜手术中F值为0.44。腹腔镜手术血液标本的执行误差的中位数(MDPE)=-17%,执行误差绝对值的中位数(MDAPE)=22.88%,摆动度=11.7%,实测血药浓度与公式计算浓度的相关系数r=0.83;非腹腔镜组MDPE=5.37%,MDAPE=16.02%,摆动度=15.86%,r=0.90。结论:按MDPE<15%,MDAPE<30%的临床接受标准,可以认为该公式可用于腹腔镜手术中测算异氟醚血药浓度,能够保证腹腔镜手术术中平稳,术后苏醒迅速完全。

Objective： To estimate the blood concentration of isoflurane with the inspired and expired concentrations during laparoscopic surgery. Methods： 2 sections were divided in this experi, ment： section 1：23 adult patients （ASA Ⅰ -Ⅱ） were received abdomina surgeries,of Whom 12 patients for non-laparoscopic surgeries and the others for laparoscopic surgeries： Central venous blood samples were collected for gas chromatography determination 20, 40, 60, 80 min after inhalating isoflurane. We could receive two different F value （the fraction of uptake of isoflurane） through the formula. Section 2： 27 patients were recruited for abdominal surgeries, t3 for laparoscopic surgeries and the others for non-laparoscopic surgeries. All of the processes were the same as the former. Then we confirm the results obtained from section1. Results： The F was 0.52 in the laparoscopic surgeries and 0.44 in the non-laparoscopic surgeries. In the laparoscopic surgeries, the bias （MDPE） was -17%, accuracy （MDAPE） was 22.88% and the wobble was 11.7% .The correlation coefficient （r） was 0.83. In the non-laparoscopic surgeries, the MDPE was 5.37%, the MDAPE was 16.02% ;the wobble was 15.86% .The correlation coefficient was 0.90. Cenclasten： The formula could be Used in abdominal surgeries to evaluate the concentration of isoflurane according to the clinical standard of MDPE〈15%, MDAPE〈30, which permits safety during laparoscopic surgeries and rapid recovery from anesthesia.