异丙酚靶控输注用于肥胖人群的可行性研究

Research of Functional Influence of Body Mass Index Effect on Target Controlled Infusion of Propofol in Surgery Patients with Obesity

【目的】探讨异丙酚靶控输注（TCI）用于肥胖人群的可行性。【方法】将本院80例行腹腔镜胆囊切除术患者根据体质量指数（BMI）不同分为两组，正常体质量组（BMI〈25kg／m2）38例，肥胖组（BMI30～40kg／m2）42例，两组均静脉注射芬太尼2～3μg／kg，靶控输注异丙酚，异丙酚初始血浆靶浓度（Ct）为3．0μg／mL，达到血浆靶浓度30s后增加0．3μg／mL，OAA／S评分=1分后静脉注射罗库溴铵0．6mg／kg，2min后进行气管插管；记录比较两组各阶段异丙酚Ct的脑电双频谱指数（BIS）值、麻醉时间、手术时间和苏醒时间。【结果】两组手术时间及麻醉时间相比较差异无显著性（P〉0．05），肥胖组苏醒时间较正常体质量组延长，且两组比较差异有显著性（P〈0．05）。两组患者异丙酚D与BIS值均呈负相关（P〈0．05），但肥胖患者的相关程度要显著低于正常体质量患者，且两组相比较差异有显著性（P〈0．05）。【结论】异丙酚TCI可用于肥胖患者，但是较正常体质量患者且性能相对降低。

[Objective]To investigate the feasibility and prospects of target controlled infusion （TCI） with propofol on obese subjects. [MethodslEighty patients were divided into two groups according to the BMI index： the normal weight group （BMI -〈 25 kg/m2）, and the obese weight group （BMI 30~40 kg/m2 ）. Fentanyl was intravenous 2~3 μg/kg, and propofol was given by target controlled infusion method. The initial target plasma concentration of propofol was set at 3.0 μg/mL. After the target concentration was steadily maintained for 30s, it was increased 0.3μg/mL. Intravenous 0.6 mg/kg of rocuronium was added when OAA/S score was 1 point and tracheal intubation was performed 2 minutes later. Brain bispectral index （BIS） in every stage of propofol target plasma concentration （Ct） , anesthesia time, operation time, and recovery time of all the patients were recorded. [ResultslThere were no statistically significant differences on surgery and anesthesia time between the two groups （ P D0.05）, the obese group, however, did have longer awakening time than normal weight group （ P 〈0.05）. Propofol Ct and BIS value were both inversely proportional in the two groups of patients （ P〈0.05）, but the correlation of obese patients was lower than normal weight patients （ P 〈0.05）. [Conclusion]Propofol TCI can be used in obese patients during surgery, but the performance will be reduced.