正常体重患者丙泊酚麻醉用量与左臂肱三头肌皮下脂肪厚度的关系

Relationship between the dosage of propofol and the thickness of the subcutaneous fat in the left arm's triceps brachii in the normal-weight patient during the general anesthesia

关键词:  丙泊酚  皮下脂肪  脑电双频指数（BIS）  镇静

Key words:  propofol  subcutaneous fat  bispectral index (BIS)  sedation

摘要:

目的　探讨静脉麻醉药丙泊酚的临床应用剂量与左臂肱三头肌皮下脂肪厚度的关系。　方法　选择33例择期行腹腔镜胆囊切除术的患者，ASAⅠ级，按照左臂肱三头肌皮下脂肪厚度分为两组：M组17例（女性12~22 mm，男性5~13 mm）和F组16例（女性26~31 mm，男性19~24 mm）。麻醉诱导药物均应用丙泊酚1 mg·kg-1、咪达唑仑0.05 mg·kg-1、芬太尼4 μg·kg-1、顺式阿曲库铵0.2 mg·kg-1。麻醉维持应用丙泊酚和瑞芬太尼20 μg·(kg·h)-1 ，以脑电双频指数（BIS）值在40~60为标准调节丙泊酚的剂量。术中监测心率、无创血压、指尖脉氧、呼气末二氧化碳、BIS。术后观察记录麻醉用药剂量、麻醉术后相关并发症。比较各时刻点心率、血压及BIS波动，比较两组手术时间、麻醉时间及麻醉药物的应用剂量。　结果　共计30例患者的数据进入实验讨论阶段，每组各15例。M组插管前、后BIS值分别为51.0±10.0和60.7±9.4，插管后与插管前比较差异有显著性意义（P<0.05）。M组和F组在丙泊酚最终应用剂量上比较，差异无显著性意义（P>0.05）。　结论　在手术时间<100 min，麻醉时间<120 min的腹腔镜胆囊切除术中，静脉麻醉药丙泊酚的临床应用剂量与患者左臂肱三头肌皮下脂肪厚度无明显关系，但具有一定临床指导价值。

Abstract:

Objective　To discuss the relationship between the dosage of propofol and the thickness of the subcutaneous fat in the left arm's triceps brachii in the normal-weight patient during the general anesthesia.　Methods　We analyzed 33 patients who were undergoing laparoscopic cholecystectomy, ASA classificationⅠ. They were allocated into two groups: M group, 17 patients(female: 12-22 mm, male: 5-13 mm) and F group, 16 patients (female: 26-31 mm, male: 19-24 mm), according to the thickness of the subcutaneous fat of the triceps brachii. The same induction of anesthesia in two group: propofol 1 mg·kg-1, midazolam 0.05 mg·kg-1, fentanyl 4 μg·kg-1 and cis-atracurium 0.2 mg·kg-1. Choose the propofol and remifentanil maintainance. Dosage of propofol anesthesia was controlled with BIS, a BIS score of 40-60 was targeted during sleep periods. The heart rate, blood pressure(MAP), SpO2, BIS, the dosage of all drugs postoperatively was recorded.　Results　We found no significant difference the dosage of propofol in two group(P>0.05). However, the BIS in the time of before intubation and after intubation respectively is 51.0±10.0, 60.7±9.4. This results has significant (P<0.05).　Conclusion　 In the undergoing laparoscopic cholecystectomy, when operation is shorter than 100 min and the time of anesthesia is shorter than 120 min, the dosage of clinically used propofol and the thickness of the subcutaneous fat in the left arm's triceps brachii, don't have any relationship. But we think this result has value for our clinic work.