阻塞性黄疸对患者地氟烷ⅣIAC·awake的影响.docVIP

阻塞性黄疸对患者地氟烷ⅣIAC·awake的影响 上海第二军医大学附属东方肝胆外科医院麻醉科 宋建钢 曹云飞 杨立群 俞卫锋 李泉 宋金超 【摘要】 目的 观察阻塞性黄疸对患者地氟烷MAC-awake的影响。 方法选择行择期肝胆手术的阻塞性黄疸患者24例，非黄疸患者20例。所有患者术前均不用任何镇静或镇痛药，单纯地氟烷吸入诱导。呼气末麻醉气体浓度首先升至1．4％，并维持15min，然后由同一观察者以中等语调命患者睁开眼睛，若患者能做出正确反应，则升高地氟烷0．1％，再维持此浓度15min后，重复命令，若仍能做出正确反应，则继续升高地氟烷0．1％。直至地氟烷浓度升高到使患者不能再对声音命令做出正确时，MAC-awake的测定结束，以患者对声音命令有正确反应的最高浓度和无反应的最低浓度的平均值作为患者的MAC-awake值。 结果 与非黄疸患者相比，阻塞性黄疸组患者的MAC-awake明显降低(P0．01)，并且与血中总胆红素的含量呈负相关(r= -0．67；P=0．0004)。结论 阻塞性黄疸患 者对地氟烷催眠效能的敏感性升高。 【关键词】 阻塞性黄疸；地氟烷：苏醒时肺泡有效浓度；总胆红素 (此文英文稿件己被《Anesthesiology》杂志接收，并修回) Awakening Concentration of Desflurane Is Decreased in Patients with Obstructive Jaundice 【Abstract】 Objective To observe the effect of obstructive jaundice on the desflurane MAC-awake of patients．Methods Patients underwent inhalational induction of anesthesia with desfiurane．MAC-awake was determined in each patient by observing the response to a verbal command (open eves on request)．An end-tidal anesthetic concentration was maintained at an initial target level of l.4％for 15 min before a command．If a positive response was observed，the concentration of desflurane was increased by 0.1％ and again kept constant for 15 min．The verbal command was then continued．This process was repeated until an end-tidal concentration was reached at which the patient failed to respond to command．The anesthetic concentration midway between the value permitting the response and that just preventing the response was defined as MAC-awake for each patient．Result The MAC-awake of desflurane for patients with obstructive jaundice (1.78％±0.19％) was significantly less than those observed for the control group(2.17％±0.25%，P0.01)，and correlated significantly with serum total bilirubin (r= -0.67；P=0.0004). Conclusion MAC-awake of desflurane is reduced in obstructive jaundiced patients compared with that of nonjaundiced controls． 【Key words】 obstructive jaundice：desflurane；minimum alveolar concentration-awake；total bilirubin MAC-awake (the minimum alveolar co