昼夜节律对全身麻醉中使用丙泊酚剂量的影响

Influence of Circadian Rhythm on the Does of Propofol in General Anesthesia

目的观察昼夜节律对全身麻醉中使用丙泊酚剂量的影响。方法选取2013年6月至2014年6月成都市第一人民医院行阑尾切除术患者60例（手术时间90min内）,按接受手术的时间分为B组即白天组（9：00-18：00）、D1组即夜间1组（21：00-0：00）和D2组即夜间2组（0：00-3：00）,每组各20例。3组患者采用统一诱导方法,术中以目标脑电双频指数（BIS）值（40-55）闭环反馈靶控输注（TCI）丙泊酚3μg/mL,瑞芬太尼TCI4ng/mL至术毕。分别记录3组患者T0（入室后5min）、T1（插管即刻）、T2（插管后5min）、T3（手术结束时）、T4（拔管时）和T5（拔管后5min）的BIS值以及平均动脉压（MAP）、心率（HR）;记录3组患者麻醉期间丙泊酚和瑞芬太尼使用的总量及停药后的麻醉苏醒时间。结果 D2组的MAP、HR均低于B组,麻醉前后的BIS值也低于B组,差异有统计学意义（P〈0.05）。在同一麻醉深度下,D2组所需的丙泊酚用量低于B组,差异有统计学意义（P〈0.05）。结论昼夜节律可以对全身麻醉中的丙泊酚用量产生影响,夜间手术的全身麻醉中丙泊酚所需药量低于白天,可以适当减量。

Objective To observe the influence of circadian rhythm on the dose of propofol in general anesthesia. Methods 60 patients who needed appendectomy were divided into three groups by their surgery time：day group （9：00-18：00） ,night groupl （21 ：00-0：00） ,night group2 （0：00-3：00） ,n=20. All patients received anesthesia induction in the same way. BIS was set at 40-55, as the feedback control variable, while the serum target-control concentration of propofol was set at 3 9g/mL, remifentail was 4 ng/mL. Record the blood pressure,heart rate and BIS at the time To （5 min after the break） ,T1 （intubation） ,T2 （5 rain after intuhation） ,T3 （the time surgery over）, T4 （extuhation）,T5 （5 rain after extubation） ; record the dose of propofol and remifentail of all patients; record the anesthesia recovery time. Results Both the blood pressure and heart rate of patients in group D2 were lower than that in group B; and the BIS before and after anesthesia was lower than group B too. At the same anesthesia level, the dosage of propofol in group D2 was less than which in group B. Conclusion The circadian rhythm may have effect on the dose of propofol,we can use less propofol on the patients who need surgery in the night.