睡眠障碍患者血浆食欲素A对丙泊酚靶控输注效应室靶浓度的影响

目的观察睡眠障碍患者接受丙泊酚全身麻醉靶控输注效应室靶浓度(target concentration of effect-site,Ce)的变化,探讨血浆食欲素A与丙泊酚Ce的相关性。方法选取2018年6-12月择期手术患者66例,男31例,女35例,年龄40~60岁,ASAⅠ或Ⅱ级,于术前1 d根据PSQI量表得分分为两组:睡眠障碍组(SD组,n=32)和正常睡眠组(NS组,n=34)。入室后常规心电监护、面罩吸氧,留取静脉血检测血浆食欲素A浓度。在BIS监测下进行丙泊酚阶梯式血浆靶控输注,初始血浆靶浓度(target concentration of plasma,Cp)设定为1.0μg/ml,当Ce达到1.0μg/ml后,每30秒以0.2μg/ml递增Cp,并呼唤患者姓名直至意识消失。继续每30秒以0.2μg/ml递增Cp直至BIS<60稳定30 s以上,停止增加Ce稳定5 min后停止输注。停药后每30秒轻拍并呼唤患者姓名直至有反应。记录患者意识消失时丙泊酚Ce(Ce1)、BIS<60稳定30 s以上对应的丙泊酚Ce(Ce2)和苏醒时丙泊酚Ce(Ce3)。采用Pearson检验分析Ce与食欲素A浓度的相关性。结果与NS组比较,SD组丙泊酚Ce1(2.53±0.26)μg/ml vs(2.38±0.30)μg/ml]、Ce2(3.30±0.35)μg/ml vs(3.15±0.28)μg/ml]和Ce3(1.76±0.38)vs(1.59±0.26)μg/ml]浓度均明显升高(P<0.05),血浆食欲素A浓度明显升高(75.09±16.50)pg/ml vs(39.96±13.78)pg/ml,P<0.05]。NS组血浆食欲素A浓度与Ce1、Ce2、Ce3均存在中度正相关(r=0.636,0.578,0.344),SD组血浆食欲素A浓度与Ce1、Ce2、Ce3也存在中度正相关(r=0.635,0.415,0.467)(P<0.05)。结论术前合并睡眠障碍患者接受丙泊酚全身麻醉需要更高的效应室靶浓度,潜在的机制可能与血浆食欲素A浓度升高有关。

Effect of orexin-A on the target concentration of effect-site of target-controlled propofol infusion during general anesthesia in patients with sleep disorders

Objective To observe the target concentration of effect-site(Ce)of target-controlled propofol infusion during general anesthesia in patients with sleep disorders,and to explore the correlation between orexin-A and Ce of propofol.Methods Sixty-six patients scheduled for elective surgery in the First Affiliated Hospital of Anhui Medical University during June to December 2018,31 males and 35 females,aged 40-60 years,falling into ASA physical statusⅠorⅡ,were divided into sleep disorder group(group SD,n=32)and normal sleep group(group NS,n=34)according to the score of the PSQI assessed the day before surgery.Standard monitoring was conducted,and oxygen was inhaled through a face mask during the observation.Blood samples were collected before observation.Patients were monitored by BIS when receiving propofol step-controlled plasma infusion.The initial target concentration of plasma(Cp)was set as 1.0μg/ml.When the Ce reached 1.0μg/ml,Cp was increased by 0.2μg/ml every 30 seconds.The patients were asked to open their eyes every 30 seconds by an observer.After loss of consciousness,the Ce was increased by 0.2μg/ml every 30 seconds until BIS was lower than 60 for more than 30 seconds.The injection of propofol was stopped 5 minutes later,and then the patients were asked to open their eyes every 30 seconds.The Ce of propofol was recorded when the patients were unconscious(Ce1),BIS was lower than 60 for more than 30 seconds(Ce2)and awaken(Ce3).After the observation and before the surgery,the anesthesia induction was conducted for the surgery.Results The Ce1(2.53±0.26)μg/ml vs(2.38±0.30)μg/ml],Ce2(3.30±0.35)μg/ml vs(3.15±0.28)μg/ml],Ce3(1.76±0.38)vs(1.59±0.26)μg/ml]in group SD was significantly higher compared to group NS(P<0.05),and the concentration of orexin-A in group SD was higher than that in group NS(75.09±16.50)pg/ml vs(39.96±13.78)pg/ml,P<0.05].There was a moderate positive correlation between orexin-A concentration and Ce1,Ce2,Ce3 both in group NS(r=0.636,0.578,0.344)and group SD(r=0.635,0.415,0.467)(P<0.05).Conclusion Preoperative sleep disorder can increase the effect or site concentration of propofol with targert control infusion during general anesthesia,and the potential mechanism may be related to the increased plasma orexin A levels.