昼夜节律对丙泊酚麻醉深度的影响

Influence of Circadian Rhythm on Depth of Propofol Anesthesia

关键词:  昼夜节律  丙泊酚  麻醉深度  脑电双频指数

Key words:  circadian rhythm  propofol  depth of anesthesia  bispectral index

摘要:

目的 研究昼夜节律对丙泊酚全麻诱导时麻醉深度的影响。方法 选择白天组(8：00~12：00)和夜间组(22：00~2：00)全麻手术患者各30例，年龄20~45岁，ASA I级，无睡眠障碍。丙泊酚靶控效应室浓度自1.0 μg·mL^-1开始，每次增加0.5 μg·mL^-1直至3.0 μg·mL^-1。静注咪唑安定0.05 mg·kg^-1、芬太尼5 μg·kg^-1、顺式阿曲库铵0.15 mg·kg^-1，3 min后行气管插。依次记录靶控输注前(T₀)及各效应室浓度平衡2 min后(T₁：1.0 μg·mL^-1、T₂：1.5 μg·mL^-1、T₃：2.0·mL^-1、T₄：2.5 μg·mL^-1、T₅：3.0 μg·mL^-1)及插管前(T₆)各时点的BIS值、平均动脉压、心率。结果 夜间组患者在T₃、T₄、T₅、T₆时其BIS值明显低于白天组患者(P<0.05)。在诱导期间平均动脉压和心率随麻醉的加深而降低，组间差异均无统计学意义(P>0.05)。结论 昼夜节律对丙泊酚麻醉深度有明显的影响，相同效应室浓度下夜间镇静程度比白天深。

Abstract:

OBJECTIVE To investigate the influence of circadian rhythm on anesthesia depth of propofol. METHODS Patients undergoing general anesthesia within 8：00~12：00 or 22：00~2：00 were chosen as day group and night group (n=30 each group). All the patients aged 20~45 years without sleep disorder. Anesthesia was induced with propofol delivered by target controlled infusion(TCI). The initial effect-site concentration of propofol was set at 1.0 μg·mL^-1, and increased step-by-step with 0.5 μg·mL^-1 after having balanced for 2 min until reached 3.0 μg·mL^-1. And then patients were injected with midazolum 0.05 mg·kg^-1, fentanyl 5 μg·kg^-1 and cisatracurium 0.15 mg·kg^-1 by intravenous before tracheal intubation. The bispectral index(BIS), MAP and HR values were recorded before propofol infused(T₀), at each effect-site concentration of propofol (T₁: 1.0 μg·mL^-1; T₂: 1.5 μg·mL^-1; T₃: 2.0 μg·mL^-1; T₄: 2.5 μg·mL^-1; T₅: 3.0 μg·mL^-1) and before tracheal intubation(T₆). RESULTS The BIS values were significantly lower at T₃, T₄, T₅ and T₆ in night group compared with day group(P<0.05). The MAP and HR were gradually decreased when induction, but without significant difference between the two groups(P>0.05). CONCLUSION Circadian rhythm may have remarkable effect on the depth of propofol anesthesia, and it is more potent when administered at night.