中医体质分型对全麻诱导时七氟醚MAC值的影响

Influence of traditional Chinese medicine constitution classification on MAC of sevoflurane during induction of general anesthesia

目的:探讨气管插管全麻诱导时,在常见的四种中医体质分型患者中,吸入七氟醚使意识消失的最低肺泡有效浓度的半数有效浓度(EC_(50))的差异。方法:研究纳入80例拟择期行气管插管全麻手术患者,根据《中医体质分类与判定》标准分为平和质(A组)、血瘀质(B组)、阴虚质(C组)、阳虚质(D组)共四组,每组20例。以吸入麻醉药七氟醚诱导麻醉,使患者意识消失,设定起始七氟醚的呼气末浓度为1.72%,并计算出5个阶梯的七氟醚呼吸末浓度值,分别为0.84%、1.21%、1.72%、2.45%和3.50%,最终用序贯法测定患者意识消失时七氟醚最低肺泡浓度的EC_(50)。结果:四组病人意识消失时七氟醚EC_(50)及对应的95%可信区间(CI)分别是:A组EC_(50)为2.37%(95%CI:1.97%~2.85%);B组EC_(50)为2.21%(95%CI:1.88%~2.58%):C组EC_(50)为2.83%(95%CI:2.63%~3.03%);D组EC_(50)为1.85%(95%CI:1.57%~2.18%)。结论:七氟醚最低肺泡有效浓度在不同中医体质患者中的存在一定差异性,阳虚患者七氟醚EC_(50)比阴虚患者明显降低。

Objective:To investigate the difference of the minimum alveolar concentration(MAC)EC_(50)of consciousness loss induced by inhalation of sevoflurane in patients with four common TCM constitution types during induction of tracheal intubation and general anesthesia.Methods:80 patients who planned to undergo endotracheal intubation operation under general anesthesia were included in this study.According to the classification and judgment of Physique of Traditional Chinese Medicine,they were divided into four groups:Balanced constitution(Group A),blood stasis constitution(group B),Yindeficiency constitution(group C)and yang-deficiency constitution(group D),with 20 cases in each group.The inhalation anesthetic sevoflurane was used to induce anesthesia and make the patient lose consciousness.The initial end respiratory concentration of sevoflurane was set at 1.72%.The concentrations of sevoflurane at the end of respiratory were calculated in 5 steps,which were 0.84%、1.21%、1.72%、2.45%and 3.50%,respectively.Finally,the EC_(50)of the lowest alveolar concentration of sevoflurane was measured by sequential method.Results:The EC_(50)of sevoflurane and corresponding 95%confidence intervals(CI)was 2.37%in group A(95%CI:1.97%-2.85%).EC_(50)in group B was 2.21%(95%CI:1.88%-2.58%),and EC_(50)in group C was 2.83%(95%CI:2.63%-3.03%).The EC_(50)of group D was 1.85%(95%CI:1.57%-2.18%).Conclusion:The MAC of sevoflurane was different in patients with different TCM constitution.The EC_(50)of sevoflurane in patients with Yangdeficiency was significantly lower than that in patients with Yindeficiency.