不同海拔地区腹腔镜胆囊手术全麻患者丙泊酚麻醉诱导时的靶控输注研究

RESEARCH ON TARGET CONTROLLED INFUSION OF PROPOFOL INDUCTION IN LAPAROSCOPIC CHOLECYSTECTOMY AT DIFFERENT ALTITUDES

目的确定不同海拔地区腹腔镜胆囊手术全麻患者丙泊酚靶控输注下意识消失界点相对应的效应室浓度、血浆浓度及相应剂量的EC05、EC50、EC95及AAI参数。方法将ASA Ⅰ～Ⅱ级LC手术病人根据海拔不同分为A组(海拔约2200m)、B组(海拔约3000m)、C组(海拔约4000m),监测听觉诱发电位AAI值。用靶浓度控制输注法输注丙泊酚,以预期效应室浓度1.2μg·mL-1为起点,每次丙泊酚的效应室浓度和血浆浓度达到一致后增加0.3μg·mL-1,直至患者意识消失。采用概率单位回归分析计算意识消失时丙泊酚的效应室浓度、血浆浓度和相对应剂量的EC05、EC50、EC95以及AAI值。结果不同海拔地区患者TCI丙泊酚意识消失时效应室浓度EC05、EC50、EC95值:A组,1.81、3.01、4.16μg·mL-1;B组,1.98、3.01、4.11μg·mL-1;C组,1.87、3.04、4.21μg·mL-1。血浆浓度EC05、EC50、EC95值:A组,2.26、3.43、4.58μg·mL-1;B组,2.41、3.46、4.54μg·mL-1;C组,2.29、3.55、4.81μg·mL-1,相应剂量EC05、EC50、EC95值:A组,0.70、1.64、2.56 mg/kg;B组,0.83、1.65、2.49 mg/kg;C组,0.73、1.63、2.53 mg/kg。三组间效应室浓度、血浆浓度、剂量的EC05、EC50、EC95比较均无明显差异性(P>0.05)。AAI值均小于30。结论不同海拔地区腹腔镜胆囊手术全麻患者TCI丙泊酚意识消失时效应室浓度、血浆浓度、相应剂量的EC05、EC50、EC95及AAI值等临床参数无明显差异,但低于白种人和国人其他研究报道。

Objective To determine the corresponding dosages concerning effect-site concentration,plasma concentration,and EC 05,EC 50,EC 95 and AAI parameters corresponding to the consciousness loss boundary point under propofol target controlled infusion in laparoscopic cholecystectomy at different altitudes.Methods According to different altitudes,divided LC patients of Level ASA I ～Ⅱ into Group A（altitude around 2,200m）,Group B（altitude around 3,000m） and Group C（altitude around 4,000m）,and monitored the auditory-evoked potential AAI value.Propofol was used to infuse the target concentration controlled infusion,and with the expected effect-site concentration 1.2 μg·mL-1 as the starting point,0.3 μg·mL-1 was added once when the effect-site concentration of propofol was consistent with the plasma concentration of propofol,until the patient＇s consciousness was lost.Probability unit regression analysis was adopted to calculate the effect-site concentration,plasma concentration,and EC 05,EC 50,EC 95 and AAI value of corresponding dosage when the consciousness was lost.Results EC 05,EC 50 and EC 95 values of TCI propofol of patients in different altitudes when their consciousness was lost：Group A,1.81,3.01,4.16 μg·mL-1;Group B,1.98,3.01,4.11 μg·mL-1;Group C,1.87,3.04,4.21 μg·mL-1.EC 05,EC 50,C 95 values of plasma concentration：Group A,2.26,3.43,4.58μg · mL-1; Group B,2.41,3.46,4.54 μg·mL-1;Group C,2.29,3.55,4.81μg·mL-1;EC 05,EC 50,EC 95 values of corresponding dosage：Group A,0.70,1.64,2.56 mg/kg;Group B,0.83,1.65,2.49 mg/kg;Group C,0.73,1.63,2.53 mg/kg.There was no significant difference in effect-site concentration,plasma concentration and EC 05,EC 50 and EC 95 of dosage among the three groups（P 0.05）and all AAI values were less than 30.Conclusion There is no significant difference in the effect-site concentration,plasma concentration,and EC 05,EC 50,EC 95 and AAI values of corresponding dosages and other clinical parameters of laparoscopic cholecystectomy general anesthesia patients in different altitudes when the TCI propofol consciousness lost,but they are lower than the report on the Caucasian and other domestic research reports.