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阻塞性黄疸患者吸入麻醉药的敏感性和血流动力学效应研究
A clinical prospective comparison of anesthetics sensitivity and hemodynamic effect among patients with or without obstructive jaundice
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DOI:
作者:
於章杰
YU Zhangjie,YANG Liqun,YU Weifeng
作者单位:
上海交通大学医学院附属仁济医院
Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai
关键词:
阻塞性黄疸;异氟烷;敏感性;血流动力学效应
obstructive jaundice; isoflurane; sensitivity; hemodynamic effect
摘要:
背景: 比较异氟烷麻醉下行肝胆外科手术的高胆红素血症和胆红素正常患者。 方法: 研究42例阻塞性黄疸和40例肝功能正常对照组患者在异氟烷麻醉下行肝胆外科手术。1.5-2mg/kg丙泊酚和2ug/kg瑞芬太尼麻醉诱导,气管插管后,控制异氟烷和氧气混合气体流量,维持脑电双频指数(BIS)在46-54左右。使用麻黄碱,阿托品和瑞芬太尼维持血流动力学变化在基线上下30%以内波动。记录平均动脉压(MAP),心率(HR),药物剂量和麻醉恢复时间。 结果: 2组患者各项基本指标和BIS值相似,阻塞性黄疸组,在麻醉诱导和维持中,使用了较多的麻黄碱和阿托品,较少的瑞芬太尼和异氟烷(51.1±24.2 vs. 84.6 ±20.3mg/min; P﹤0.05)。尽管麻醉药的用量较小,阻塞性黄疸组患者的恢复时间和拔管时间相比对照组显著延长。 结论: 阻塞性黄疸患者对异氟烷的麻醉药敏感性增强,麻醉诱导和维持中更易出现低血压和心动过缓,并且,麻醉恢复时间和拔管时间相对于非黄疸患者有明显延长。
Background: To compare isoflurane anesthesia in patients with or without hyperbilirubinemia undergoing hepatobiliary surgery. Methods: Forty-two patients with obstructive jaundice and 40 control patients with normal liver function scheduled for hepatobiliary surgery under isoflurane anesthesia were studied. Anesthesia was induced with propofol (1.5-2mg/kg) and remifentanil (2 mg/kg). After tracheal intubation, anesthesia was titrated using isoflurane in oxygenenriched air, adjusted to maintain a bispectral index (BIS) value of 46–54. Ephedrine, atropine and remifentanil were used to maintain hemodynamic parameters within 30% of the baseline. The mean arterial blood pressure (MAP), heart rate (HR), drug doses and the time taken to recover from anesthesia were recorded. Results: Demographic data, duration and BIS values were similar in both groups. Anesthesia induction and maintenance were associated with more hemodynamic instability in the patients with jaundice and they received more ephedrine and atropine and less remifentanil and isoflurane (51.1±24.2 vs. 84.6±20.3mg/min; P for all <0.05) than control patients. Despite less anesthetic use, the time to recovery and extubation was significantly longer than that in control. Conclusion: Patients with obstructive jaundice have an increased sensitivity to isoflurane, more hypotension and bradycardia during anesthesia induction and maintenance and a prolonged recovery time compared with controls.
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