摘要
背景妊娠时孕妇对镇静药的需要量减少，据称与孕酮有关。然而，妊娠和孕酮对丙泊酚的需要量产生怎样的影响，至今没有人彻底的研究过。本研究的目的是确定在妊娠早期，麻醉诱导意识消失期间和麻醉苏醒睁眼时所用丙泊酚的剂量和预测效应室靶浓度是否减低。同时观察血孕酮的含量与使意识消失时丙泊酚剂量和效应室靶浓度有无相关性。方法我们研究了57例ASA1-2级拟行终止妊娠的患者和55例行经阴道卵泡穿刺体外受精的对照患者。浓度为1％的丙泊酚以200ml／min的输注速度实施麻醉。记录在诱导时意识丧失过程中所用丙泊酚的剂量和预测效应室靶浓度（Schnider模型）。同时预测在麻醉苏醒睁眼时的效应室靶浓度。血孕酮的量在手术结束时测定。结果在意识消失时，妊娠患者较非妊娠患者所用丙泊酚剂量的平均值（±1个标准差）显著减少（分别为108．57±20．04mg和117．59±17．98mg，P=0．014）。与之相似，意识消失时预计的丙泊酚效应室靶浓度在妊娠患者有显著的降低。在麻醉苏醒睁眼时丙泊酚的预计靶浓度没有差别。没有观察到血孕酮水平与意识消失时丙泊酚的剂量和效应室靶浓度的相关性。结论早期妊娠时使意识消失的丙泊酚的剂量和预计的效应室靶浓度减低。孕酮并不能解释这一结果。
BACKGROUND： Pregnancy is associated with decreased hypnotic requirement, allegedly related to proges- terone. However, the effects of pregnancy and progesterone on propofol requirement have not been thoroughly investigated. We conducted this study to determine whether propofol dose and predicted effect-site concentration for loss of consdousness （LOC） during induction of anesthesia, and eye opening during emergence from anesthesia, are decreased during early preg- nancy. We also investigated whether blood progesterone was correlated with propofol dose and effect-site concentration for LOC. METHODS： We studied 57 ASAⅠ -Ⅱwomen patients undergoing elective termination of pregnancy and 55 control patients undergoing transvaginal oocyte puncture for in vitro fertilization. Anesthesia was induced by administration of a 1% propofol infusion at200 ml/min. Propofol dose and calculated effect-site concentration （Schnider model） were recorded at the time of LOC during induction. We also calculated effect-site concentration at the time of eye opening upon emergence from anesthesia. Blood progesterone was measured after surgery. RESULTS： Mean （ ±1SD） propofol dose at LOC was significantly reduced in the pregnant patients compared with the nonpregnant control patients （108.57 ± 20. 04 vs 117.59 ± 17. 98 nag, respectively; P = 0. 014）. Similarly, the calculated propofol effect-site concentration at LOC was significantly lower in the pregnant patients than the nonpregnant control patients （4. 59±O. 72 vs 5.01± 0. 64 g/ml, respectively; P = 0. 0014）. There was no difference in the calculated effect-site concentration on eye opening upon emergence. No significant relationship was observed between blood progesterone and propofol dose or calculated propofol effect-site concentration at LOC. CON- CLUSION： Propofol dose and predicted propofol effect-site concentration at LOC are decreased during early pregnancy. Progesterone does not explain this resuk.
作者
Nicolas Mongardon, MD
Frederique Servin, MD, PhD
Mathilde Perrin, MD
Ennoufous Bedairia, MD
Sylvie Retout, PhD
Chadi Yazbeck, MD, PhD
Philippe Faucher, MD
Philippe Montravers, MD, PhD
Jean-Marie Desmonts, MD
Jean Guglielminotti, MD
谢珺田（译）
出处
《麻醉与镇痛》
2012年第1期34-39,共6页
Anesthesia & Analgesia
