李晓晶　杨改生　张小光

[摘要] 目的 研究靶控输注丙泊酚时性别对丙泊酚效应室浓度的影响。 方法 选择2014年3～8月于解放军空军总医院择期行胸、腹部手术患者30例，根据性别分为男性组（A组）和女性组（B组），每组各15例。麻醉诱导选用威力方舟（Diprifusor）软件内嵌Schnider丙泊酚药代模型和Minto瑞芬太尼药代模型，靶控输注模式选择血浆靶控，血浆药物浓度丙泊酚4 μg/mL，瑞芬太尼4 ng/mL，分别于靶控输液 30 s（T0）、60 s（T1）、患者意识消失时（T3）、效应室浓度到达4 μg/mL时（T4）记录各时间点脑电双频指数（BIS）、丙泊酚效应室浓度，并于各时间点经桡动脉采血2 mL测定丙泊酚实际血药浓度，连续监测平均动脉压（MAP）和心率。 结果 两组BIS值各时间点比较差异无统计学意义（P > 0.05），且各时间点两组患者血流动力学指标差异无统计学意义（P > 0.05）。T4时丙泊酚效应室浓度B组高于A组，差异有统计学意义（P < 0.05）；但是丙泊酚实际血药浓度两组比较，差异无统计学意义（P > 0.05）。 结论 靶控输注丙泊酚时，即意识消失时影响麻醉深度的为丙泊酚效应室浓度而并非实测的血药浓度，且意识消失时女性所需丙泊酚效应室浓度高于男性。

[关键词] 性别；靶控输注；丙泊酚；效应室浓度；血药浓度；脑电双频指数

[中图分类号] R614 [文献标识码] A [文章编号] 1673-7210（2015）02（b）-0052-04

[Abstract] Objective To explore the influence of sex on Propofol effect-site concentration during the target controlled infusion （TCI）. Methods From March to August 2014， in General Hospital of Air Force， 30 cases of thoracic or abdominal surgery patients would undergo general anesthesia were divided into two groups， according to gender， male group （group A） and female group （group B）. Radial artery was cannulated for MAP monitoring and blood sampling， target-controlled infusion of Propofol was administered by Schnider TCI model with a single constant target plasma Propofol concentration of 4 μg/mL， and remifentanil was administered by Minto TCI model with a single constant target plasma remifentanil concentration 4 ng/mL. The bispectral index （BIS）， target plasma Propofol concentration and effect-site concentration at each time point TCI 30 s （T0）， 60 s （T1）， loss of consciousness （T3）， effect compartment concentration at 4 μg/mL （T4） were also recorded. And blood sampling 2 mL through transradial artery measured Propofol actual blood drug concentration， continuous monitored MAP and heart rate. Results There was no BIS value and the plasma of Propofol among the four time points （P > 0.05）. The effect-site concentration of Propofol in group B was higher than that in group A at T4 （P < 0.05）； but Propofol actual blood drug concentrations of two groups were compared， the difference was not statistically significant （P > 0.05）. Conclusion Compared with male， female need higher effect-site concentration of Propofol during the induction of anesthesia， and it is effect-site concentration of Propofol to determine the depth of anesthesia， not plasma concentration.

[Key words] Sex； Target controlled infusion； Propofol； Effect-site concentration； Bispectral index

丙泊酚作为一种静脉全身麻醉药物，具有起效迅速、维持时间短、苏醒迅速而完全、持续输注基本无蓄积现象等优点，因此目前普遍用于麻醉诱导、麻醉维持当中，也广泛应用于重症监护室（ICU）患者的镇静以及辅助局部麻醉患者术中及术后的镇静。尽管目前国内外关于丙泊酚药动学方面的研究有较多报道，但偏差较大。随着医……