月经周期对异丙酚麻醉半数有效剂量影响及机制研究.docVIP

月经周期对异丙酚麻醉半数有效剂量影响及机制研究 　　[摘要] 目的 探讨月经周期对异丙酚麻醉半数有效剂量的影响及机制。 方法 选择2012年1月～2014年12月间在我院行腹腔镜手术的72例妇产科患者，根据其血清孕酮水平的不同分为卵泡期组和黄体期组，每组36例。以目标靶浓度控制输注（TCI）技术经静脉靶控输注异丙酚实施麻醉诱导，起始血浆浓度设为2.0 mg/L，达到预期血浆靶浓度后每30秒递增0.5 mg/L，直至患者意识消失，药代动力学模型采用Marsh模型。记录意识消失时（T1）、BIS降至50时（T2）、患者苏醒时（T3）三个时间点的BIS、平均动脉压（MAP）、心率（HR）、异丙酚血药浓度以及半数有效剂量（ED50），并测定其激素水平。 结果 两组患者在各时间点MAP、HR及BIS值的差异均无统计学意义（P0.05），黄体期组患者的异丙酚血浆浓度在T1、T2两个时间点均低于卵泡期组，差异有统计学意义（P0.05），而与卵泡期组苏醒时间相比，黄体期组患者苏醒时间明显缩短（P0.05）。 结论 月经周期可影响异丙酚的镇静效应，全麻诱导时黄体期患者的异丙酚半数有效剂量明显减少，苏醒时间缩短，可能与孕酮水平有关。 　　[关键词] 月经周期；异丙酚；麻醉半数有效剂量 　　[中图分类号] R614 [文献标识码] A [文章编号] 1673-9701（2015）22-0012-04 　　Research on the effects and mechanism of menstrual cycle for median effective dose of propofol anesthesia 　　ZHANG Gao1 FU Feng2 　　1.Department of Obstetrics and Gynecology， Ningbo City Peoples Liberation Army 113 Hospital in Zhejiang Province， Ningbo 315000， China；2.the Affilliated Obstetrics and Gynecology Hospital of Medicine College in Zhejiang University， Hangzhou 310000， China 　　[Abstract] Objective To explore the effects and mechanism of menstrual cycle for median effective dose of propofol anesthesia. Methods The clinical data of 72 patients undergoing gynaecological laparoscopy in the hospital during Jan 2012 to Dec 2014 were divided into follicular group and luteal group according to different serum progesterone level，each group had 36 patients. Anesthesia was first induced with target controlled infusion system of propofol using Marsh pharmacokinetic model at an initial target plasma concentration of 2.0 mg/L followed by increments of 0.5 mg/L per 30 s until loss of consciousness. BIS，MAP，HR，plasma concentration of propofol，and the total induction dose of propofol were recorded at T1（loss of eyelash reflex），T2（the value of BIS below 50）and T3（recovery of anesthesia）. At the same time hormone levels were determined. Results There was no statistical diference in MAP，HR， and BIS at each time point （P0.05）.In the luteal group，the total induction dose of propofol