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| 七氟醚抑制帕金森病患者切皮时肾上腺素能反应的最低肺泡有效浓度 |
| Minimum alveolar concentration for blunting adrenergic response of sevoflurane in patients with Parkinson disease |
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| DOI：10.12089/jca.2021.08.004 |
| 中文关键词: 帕金森病 七氟醚 最低肺泡有效浓度 |
| 英文关键词: Parkinson disease Sevoflurane Minimum alveolar concentration |
| 基金项目:吴阶平医学基金会临床科研专项（320.6750.2020-21-13）；中央高校基本科研业务费专项资金（WK9110000169） |
| 作者 | 单位 | E-mail | | 唐菲 | 230036,合肥市,中国科学技术大学附属第一医院(安徽省立医院)麻醉科 | | | 杨成伟 | 230036,合肥市,中国科学技术大学附属第一医院(安徽省立医院)麻醉科 | | | 黄祥 | 230036,合肥市,中国科学技术大学附属第一医院(安徽省立医院)麻醉科 | | | 李娟 | 230036,合肥市,中国科学技术大学附属第一医院(安徽省立医院)麻醉科 | | | 康芳 | 230036,合肥市,中国科学技术大学附属第一医院(安徽省立医院)麻醉科 | 1561476059@qq.com |
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| 中文摘要: |
目的 探讨七氟醚抑制帕金森病（PD）患者切皮时肾上腺素能反应的最低肺泡有效浓度（MACBAR）。
方法 选择2019年10月至2021年3月择期行脑深部刺激器植入术患者21例，男10例，女11例，年龄40～64岁，BMI 18～30 kg/m2，ASA Ⅰ—Ⅲ级。采用吸入8%七氟醚进行麻醉诱导，喉罩置入后调整呼气末七氟醚浓度（CETSev）至预设水平。采用序贯法测定七氟醚MACBAR。第1例患者CETSev调整至3%，稳定后15 min切开锁骨下皮肤。将切皮前3、1 min HR和MAP的平均值记录为基础值，将切皮后1、3 min HR和MAP的平均值记录为变化值，若HR或MAP升高幅度超过基础值的20%则定义为肾上腺素能反应阳性。若切皮时肾上腺素能反应为阳性，下一例采用高一级浓度，否则采用低一级浓度，浓度梯度为0.2%。当出现7个“阳性反应-阴性反应”的转折点时停止试验。采用概率回归法计算七氟醚MACBAR及其95%可信区间（CI）。
结果 肾上腺素能反应阳性的患者MAP变化值明显高于肾上腺素能反应阴性的患者（P<0.05）。通过概率回归法算得PD患者切皮时七氟醚MACBAR为2.11%（95%CI 1.94%～2.27%）。
结论 七氟醚抑制帕金森病患者切皮时肾上腺素能反应的最低肺泡有效浓度为2.11%（95%CI 1.94%～2.27%）。 |
| 英文摘要: |
Objective To determine the minimum alveolar concentration for blunting adrenergic response (MACBAR) of sevoflurane in patients with Parkinson disease.
Methods Twenty-one patients,10 males and 11 females, aged 40-64 years, BMI 18-30 kg/m2, ASA physical status Ⅰ-Ⅲ, scheduled for bilateral deep brain stimulation electrode insertion and pulse generator placement from October 2019 to March 2021 were enrolled in this study. Anesthesia was induced with 8% sevoflurane. After the I-gel laryngeal mask insertion, the concentration of sevoflurane was adjusted to a preset level. The MACBAR of sevoflurane was estimated by using the Dixon up and down method. The first patient in each group received an end-tidal concentration of sevoflurane (CETSev) at 3%. The CETSev was maintained for at least 15 minutes before skin incision. HR and MAP were manually recorded 3 and 1 minutes before skin incision, and 1 and 3 minutes after incision. The baseline value of HR or MAP was defined as the average of the 3 and 1 minutes measured values before surgical pneumoperitoneum. The positive adrenergic response was defined as HR and/or MAP increasing by 20%. Each time CETSev increased/decreased by 0.2% in the next patient depending on whether or not the adrenergic response to skin incision occurred. The study was continued until the 7th positive response/negative response crossover pairs had occurred. The MACBAR of sevoflurane was estimated by calculating the mean of 7 independent crossover pairs of CETSev. Moreover, the up and down data were also analyzed using the probit analysis deriving the MACBAR with 95% confidence interval (CI).
Results Compared with those patients with negative adrenergic response, the MAP were significantly increased after incision in patients with positive adrenergic response (P < 0.05). From the probit analysis, the MACBAR of sevoflurane in PD patients was 2.11% (95% CI 1.94%-2.27%).
Conclusion The MACBAR of sevoflurane in PD patients is 2.11% (95% CI 1.94%-2.27%). |
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