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Anesth Analg:原位肝移植的患者对七氟醚浓度需求更低

2017-11-17 田 磊 “罂粟花”微信号

七氟烷是一种挥发性麻醉药,常用于行原位肝移植(OLT)术的终末期肝病(ESLD)患者的麻醉维持。越来越多的证据表明,与肝功能尚存的病人相比,终末期肝病患者对麻醉药物的需求量降低。挥发性麻醉药的效力以最小肺泡浓度(MAC)表示。在这项前瞻性盲研究中,我们对行腹部大手术肝功能正常患者和行OLD的ESLD患者的MAC值进行了比较。

背景与目的:七氟烷是一种挥发性麻醉药,常用于行原位肝移植(OLT)术的终末期肝病(ESLD)患者的麻醉维持。越来越多的证据表明,与肝功能尚存的病人相比,终末期肝病患者对麻醉药物的需求量降低。挥发性麻醉药的效力以最小肺泡浓度(MAC)表示。在这项前瞻性盲研究中,我们对行腹部大手术肝功能正常患者和行OLD的ESLD患者的MAC值进行了比较。

方  法:异丙酚麻醉诱导,通过评价行腹部大手术肝功能正常患者和OLT时的初始皮肤切口运动反应测定七氟烷MAC值。使用狄克逊“上下”法获得MAC,并比较各组之间的差异。此外,我们还记录了皮肤切开前后的脑电双频指数。

结  果:本研究包括20例接受OLT和20例对照处理的患者,接受OLT患者的MAC为1.3%(95%可信区间[CI],1.1-1.4),正常肝功能患者MAC为1.7%(95% CI, 1.6-1.9),相当于ESLD患者的MAC值相对减少了26%(95% CI, 14-39)。在切皮前3分钟(47 [95% CI, 40-53] vs 35 [95% CI, 31-40], P = .011),切皮前1分钟(48 [95% CI, 42-54] vs 37 [95% CI, 33-43], P = .03),切皮后1分钟(57 [95% CI, 50-64] vs 41 [95% CI, 36-47], P < .001), ESLD患者脑电双频指数比对照组高。

结  论:我们的研究结果表明,在异丙诱导麻醉中,与正常肝功能患者相比,终末期肝病患者七氟烷MAC是降低的。然而,我们没有测量皮肤切开时的丙泊酚浓度,MAC的差异应谨慎解释,因为在皮肤切开时可能存在残留的异丙酚。

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    2018-07-19 AspirantSuo
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    2018-08-31 经常头晕
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