【罂粟摘要】昼夜节律对全身麻醉中麻醉指数和丙泊酚靶控输注浓度的影响
昼夜节律对全身麻醉中麻醉指数和丙泊酚靶控输注浓度的影响
贵州医科大学 麻醉与电生理课题组
翻译：张中伟 编辑：佟睿 审校：曹莹
昼夜节律对药物的代谢及其疗效的影响越来越受到重视。然而，它们对全身麻醉的影响尚不清楚。本研究旨在探讨昼夜节律对麻醉深度和丙泊酚靶控输注（TCI）浓度的影响。
60名接受腹腔镜手术的患者分为以下四组。ND组（n=15）：日间（8:00–18:00)在麻醉监护下进行丙泊酚靶控输注，NN组（n=15）：夜间（22:00–5:00）在麻醉监护下进行丙泊酚靶控输注，CLTD组（n=15）：日间(8:00–18:00)在BIS引导下进行丙泊酚闭环靶控输注，CLTN组（n=15）：夜间（22:00–5:00）在BIS引导下进行丙泊酚闭环靶控输注。选取诱导前5分钟至手术结束内的7个时间点，比较ND组和NN组的麻醉指数、平均动脉压（MAP）和心率（HR），比较CLTD组和CLTN组的丙泊酚靶控输注浓度、MAP和HR。
从机械通气开始到手术结束，NN组的麻醉指数、MAP和HR均低于ND组（p<0.05）。CLTN组术前至术后的丙泊酚靶控输注浓度均低于CLTD组（p<0.05）。
在丙泊酚靶控输注期间，昼夜节律对麻醉深度和药物输注浓度有显著影响。与日间手术相比，在夜间手术中使用全身麻醉时，丙泊酚输注浓度应适当降低。
Jianghua Shen , Min Ye , Qian Chen, et al. Effects of circadian rhythm on Narcotrend
index and target-controlled infusion concentration of propofol anesthesia.[J]. BMC Anesthesiol(2021) 21:215:1.
Effects of circadian rhythm on Narcotrend index and target-controlled infusion concentration of propofol anesthesia
Abstract
Background: The effects of circadian rhythms on drug metabolism and efficacy are being increasingly recognized. However, the extent to which they affect general anesthesia remains unclear. This study aims to investigate the effects of circadian rhythms on anesthetic depth and the concentrations of propofol target‑controlled infusion (TCI).
Method:Sixty patients undergoing laparoscopic surgeries were sequentially assigned to four groups. Group ND (n = 15): Propofol TCI with Narcotrend monitor during the day (8:00–18:00), Group NN (n = 15): Propofol TCI with Narcotrend monitor during the night (22:00–5:00), Group CLTD (n = 15): Propofol closed‑loop TCI guided by bispectral index (BIS) during the day (8:00–18:00), Group CLTN (n = 15): Propofol closed‑loop TCI guided by BIS during the night (22:00–5:00). The Narcotrend index, mean arterial pressure (MAP) and heart rate (HR) were compared between group ND and NN at 7 time points, from 5 min before induction to the end of operation. The propofol TCI concentrations, MAP and HR were compared between group CLTD and CLTN at 7 time points, from 5 min after induction to the end of operation.
Results:The Narcotrend index, MAP , and HR in group NN were lower than those in group ND from the beginning of mechanical ventilation to the end of operation (p < 0.05). The propofol TCI concentrations in group CLTN were lower than those in group CLTD from the beginning of operation to the end of operation (p < 0.05).
Conclusion:Circadian rhythms have a significant effect on the depth of anesthesia and drug infusion concentrations during propofol TCI. When using general anesthesia during night surgery, the propofol infusion concentration should be appropriately reduced compared to surgery during the day.
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