女性月经周期对丙泊酚麻醉诱导用量的影响

Effects of menstrual cycle on induction dose of propofol

目的观察女性月经周期对静脉麻醉药丙泊酚麻醉诱导剂量的影响。方法选择全身麻醉下行腹腔镜妇科手术的20～40岁女性患者60例,根据其月经周期分为卵泡期组和黄体期组。术前检测雌二醇(E2)和孕酮(P)水平。应用Marsh药代动力学模型,经静脉靶控输注丙泊酚进行麻醉诱导,起始血浆浓度设为1.5mg/L,每30s递增0.5mg/L,直至患者睫毛反射消失及脑电双频指数(BIS)降至50。记录各时间点的BIS、平均动脉压(MAP)、心率(HR)、丙泊酚血药浓度以及BIS降至50时的丙泊酚麻醉诱导总量。结果黄体期组的E2和P水平均显著高于卵泡期组(P值均<0.05)。两组在各时间点MAP、HR及BIS值的差异均无统计学意义(P值均>0.05)。黄体期组患者睫毛反射消失及BIS降至50时的丙泊酚血药浓度分别为(3.12±0.37)和(3.52±0.49)mg/L,均显著低于卵泡期组的(3.38±0.41)和(3.79±0.67)mg/L(P值均<0.05)。黄体期组BIS降至50时的丙泊酚麻醉诱导总用量为(89.7±12.2)mg,显著少于卵泡期组的(106.3±13.3)mg(P<0.05)。结论与卵泡期相比,黄体期丙泊酚麻醉诱导用量明显减少。

Objective To observe the effects of menstrual cycle on induction dose of propofol. Methods Sixty patients aged 20-40 years were scheduled for gynecological laparoscopic surgery under general anesthesia and were divided into two groups according to their preoperative levels of estradiol and progesterone, that is, the follicular group and the luteal group. Anesthesia was first induced with target controlled infusion system （TCI） of propofol using Marsh pharmacokinetic model at an initial target plasma concentration of 1.5 mg/L followed by increments of 0.5 mg/L per 30 s until loss of eyelash reflex and bispectral index （BIS） reduced to 50. BIS, mean artery pressure （MAP）, heart rate （HR）, plasma concentration of propofol, and the total induction dose of propofol when BIS reduced to 50 were recorded. Results In the luteal group, the levels of E2 and P were significantly higher than those in the follicular group at each time point （P〈0.05）. However, there was no statistical difference in MAP, HR, and BIS at each time point （P〈0.05）. In the luteal group, the plasma concentration of propofol when loss of eyelash reflex （[3.12±0.37] mg/L） and BIS reduced to 50 （[3.52±0.49] mg/L） were significantly lower than those in the follicular group （[3.38±0.41], [3.79±0.67] mg/L, P〈0.05）. Simultaneously, the total induction dose of propofol when BIS reduced to 50 was significantly lower in the luteal group than the follicular group （[89.7±12.2] vs. [106.3±13.3] mg, P〈0.05）. Conclusion For female patients in the luteal phase, the induction dose needed for propofol is significantly reduced compared with those in the follicular phase.