年龄对腹部肿瘤患者丙泊酚麻醉的药效学影响

目的 探讨年龄因素对腹部肿瘤手术患者丙泊酚靶控输注麻醉中血药浓度和药效学的影响,为临床丙泊酚的合理应用提供参考。方法 回顾性分析成武县人民医院2017年6月至2020年2月收治的160例经丙泊酚靶控输注麻醉的腹部肿瘤手术患者的临床资料,按照年龄不同将其分为3组。对所有患者的脑电双频指数（bispectral index,BIS）、平均动脉压（mean arterial pressure,MAP）、警觉/镇静观察（the observer's assessment of alertness/sedation,OAA/S）评分进行常规监测,在给予患者进行丙泊酚靶控输注麻醉后,即刻进行OAA/S评分,并记录不同OAA/S评分时,患者的BIS、MAP及丙泊酚血药浓度情况。比较丙泊酚靶控输注麻醉过程中3组患者不同OAA/S评分时,其BIS、MAP、血药浓度达标需要时间。结果 各组患者MAP、BIS值随着OAA/S评分降低逐渐降低,丙泊酚血药浓度及达到OAA/S评分需要的时间逐渐升高,差异有统计学意义（P<0.05）。同一评分点下,75岁以上组患者的MAP、BIS值均明显高于其他组,丙泊酚血药浓度及达到OAA/S评分需要的时间均明显低于其他组（P<0.05）。结论 随着腹部肿瘤手术患者年龄的增加,丙泊酚靶控输注麻醉意识消失时,丙泊酚血浆浓度降低,麻醉起效较快,临床应用时需引起重视。

Effects of age on the pharmacodynamics of propofol anesthesia in patients with abdominal tumors

Objective To explore the influence of age on the blood concentration and pharmacodynamics of propofol target-controlled infusion anesthesia in patients with abdominal tumor surgery, in order to provide reference for the rational application of propofol in clinical practice. Methods The clinical data of 160 patients undergoing abdominal tumor surgery under propofol target-controlled infusion anesthesia admitted to Chengwu County People's Hospital from June 2017 to February 2020 were retrospectively analyzed, and they were divided into three groups according to age. All patients were routinely monitored for bispectral index （BIS）, mean arterial pressure （MAP）, and the observer's assessment of alertness/sedation （OAA/S） scale. Immediately after the patients were given propofol target-controlled infusion anesthesia, the OAA/S score was performed immediately, and the patients' BIS, MAP and propofol blood concentrations were recorded with different OAA/S scores. The time required for BIS, MAP and blood drug concentration to reach the standard was compared between the three groups of patients with different OAA/S scores during propofol target-controlled infusion anesthesia. Results The MAP and BIS values of the patients in each group gradually decreased with the decrease of the OAA/S score, while the blood concentration of propofol and the time required to reach the OAA/S score gradually increased; the differences of the above indicators in each group were statistically significant （P<0.05）. Under the same score point, the MAP and BIS values of patients in the over 75-year-old group were significantly higher than those of the other groups, and the blood concentration of propofol and the time required to reach the OAA/S score were significantly lower than those of the other groups （P<0.05）. Conclusion With the increase of age of patients undergoing abdominal tumor surgery, when the awareness of propofol target-controlled infusion anesthesia disappears, the plasma concentration of propofol decreases, and the onset of anesthesia is quicker, so attention should be paid to clinical application.