梗阻性黄疸对全麻术中丙泊酚用量的影响

目的探讨梗阻性黄疸对静脉麻醉中丙泊酚用量的影响。方法选择拟全身麻醉下行胆道或胰腺手术的患者35例,男24例,女11例,年龄35~70岁,ASAⅠ或Ⅱ级。根据术前1d的血清总胆红素(TBL)水平分为黄疸组(TBL17.1μmol/L,n=20)和对照组(TBL17.1μmol/L,n=15)。恒速输注丙泊酚0.3mg·kg~(-1)·min~(-1)进行麻醉诱导。输注开始后每隔20秒测试睫毛反射。记录两组患者至睫毛反射消失时丙泊酚用量,用多元线性回归(进入法)分析丙泊酚用量与血清TBL、总胆汁酸(TBA)、白蛋白(ALB)、天冬氨酸转移酶(AST)和丙氨酸转氨酶(ALT)之间的关系,用逐步法分析得出回归方程。结果至睫毛反射消失时黄疸组丙泊酚用量为(1.08±0.23)mg/kg,明显低于对照组的(1.38±0.24)mg/kg(P0.05)。黄疸组睫毛反射消失时丙泊酚用量与血清TBL存在明显的负性相关关系(r=-0.74,P0.05)。结论梗阻性黄疸患者在静脉麻醉中可减少丙泊酚用量。

Effect of obstructive jaundice on the dosage of propofol during general anesthesia

Objective To investigate the effect of obstructive jaundice on the dosage of propofol in general anesthesia.Methods Thirty-five patients (male 24 cases,females 11 cases,aged 35-70 years, ASAⅠorⅡ)for biliary or pancreatic surgery under general anesthesia were divided into obstructive jaundice group and control group based on serum total bilirubin (TBL)values.Propofol was titrated by 0.3 mg· kg-1 ·min-1 to the end point when eyelash reflex disappeared.Eyelash reflex was tested every 20 seconds. Propofol requirement in the two groups were measured and the relationship between propofol requirement and serum TBL in the jaundice group was analyzed.Results Propofol requirement in obstructive jaundice group was lower than that in the control group [(1.08 ±0.23)mg/kg vs (1.38 ±0.24)mg/kg](P <0.05).In addition,we found a significant negative correlation between serum total bilirubin and propofol re-quirement in obstructive jaundice group (r =-0.74,P <0.05).Conclusion The use of intravenous anes-thetic propofol is reduced in patients with obstructive jaundice.