本文選題：丙泊酚　切入點(diǎn)：酗酒　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:丙泊酚是目前臨床最常用的靜脈麻醉藥之一,與非飲酒者相比,酗酒會增加丙泊酚誘導(dǎo)劑量,要達(dá)到相同的麻醉深度,酗酒者所需的丙泊酚藥量相對較高。發(fā)生該現(xiàn)象的機(jī)制仍不明確,本文從藥物代謝角度,系統(tǒng)地比較了酗酒者與非酗酒組丙泊酚血藥濃度的差異,初步探討了該現(xiàn)象發(fā)生的原因,以期為臨床工作提供參考。方法:選取24名普外科擇期手術(shù)患者,采用酒精使用障礙篩查量表(AUDIT)將手術(shù)患者分為酗酒組和對照組,常規(guī)靜脈麻醉誘導(dǎo),采用靶控輸注方式給予丙泊酚,比較酗酒組和對照組患者接受丙泊酚靜脈麻醉過程中術(shù)中血壓波動事件發(fā)生率以及術(shù)后蘇醒時間的差異;建立高效液相色譜-熒光法以測定丙泊酚的血藥濃度,考察兩組患者術(shù)中及術(shù)后丙泊酚實(shí)際血藥濃度,比較其代謝差異。結(jié)果:本實(shí)驗建立了利用高效液相色譜-熒光法測定丙泊酚血藥濃度的方法,該方法靈敏度、精密度較高,回收率良好,最低定量限為0.01μg/ml,在0.1-5μg/mL濃度范圍內(nèi)線性良好,且不會受到其他常用藥物的干擾,能夠滿足本實(shí)驗測定需求,是一種快速、準(zhǔn)確的藥物定量分析方法。本實(shí)驗記錄并分析了酗酒組與對照組術(shù)中發(fā)生高血壓和低血壓事件的頻次,發(fā)現(xiàn)酗酒組發(fā)生高血壓事件的頻次略高于對照組,但差異并不顯著(P=0.096),而發(fā)生低血壓事件的頻次顯著低于對照組(P0.05)。兩組患者穩(wěn)態(tài)血藥濃度之間無明顯差異,而停止輸注丙泊酚后,兩組患者的血藥濃度存在一定差異,酗酒組血藥濃度略高于對照組(P=0.050)。這種差異提示了兩組患者之間代謝速率的不同,酗酒組患者體內(nèi)的藥物消除速率略低于對照組患者。結(jié)論:酗酒對丙泊酚麻醉效果有一定得影響,酗酒者可能對丙泊酚的麻醉效果有一定的耐受,但飲酒對丙泊酚麻醉效果的影響并非或很少程度上是通過影響丙泊酚代謝引起的,丙泊酚的血藥濃度并非是引起飲酒者與非飲酒者麻醉效果差異的關(guān)鍵因素。
[Abstract]:Objective: propofol is one of the most commonly used intravenous anesthetics in clinic at present. Compared with non-drinkers, drinking alcohol will increase the induced dose of propofol and reach the same depth of anesthesia. The mechanism of propofol in alcoholics is still unclear. From the point of drug metabolism, the differences of plasma propofol concentrations between alcoholics and non-alcoholics were systematically compared. The causes of this phenomenon were preliminarily discussed in order to provide reference for clinical work. Methods: 24 patients undergoing elective surgery in general surgery were divided into alcoholism group and control group by alcohol use disorder screening scale (AUDITT). Conventional intravenous anesthesia was induced by target-controlled infusion of propofol. The incidence of intraoperative blood pressure fluctuation and postoperative recovery time were compared between the alcoholic group and the control group during the course of intravenous anesthesia with propofol. A high performance liquid chromatography-fluorescence method was established to determine the plasma concentration of propofol, and to investigate the actual concentration of propofol during and after operation. Results: a high performance liquid chromatography-fluorescence method was established for the determination of propofol concentration in blood. The minimum quantitative limit is 0.01 渭 g / ml. The linear range of 0.1-5 渭 g / mL is good, and it is not interfered by other commonly used drugs. This study recorded and analyzed the frequency of hypertension and hypotension events in the alcoholism group and the control group, and found that the frequency of hypertension events in the alcoholic group was slightly higher than that in the control group. However, the frequency of hypotension events was significantly lower than that of the control group (P 0.05). There was no significant difference in the steady-state blood drug concentration between the two groups, but there was a certain difference between the two groups after stopping the infusion of propofol. The serum drug concentration in the alcoholic group was slightly higher than that in the control group. This difference indicated that the metabolic rate was different between the two groups. Conclusion: alcoholism has a certain effect on propofol anesthesia, and alcoholics may have some tolerance to propofol anesthetic effect. However, the influence of drinking on the anesthetic effect of propofol was not, to a certain extent, caused by the influence of propofol metabolism, and the plasma concentration of propofol was not the key factor to cause the difference between drinkers and non-drinkers.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614

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