帕金森病患者丙泊酚诱导意识消失的效应室浓度

doi:10.3969/j.issn.1006-7795.2025.06.021

摘要/Abstract

摘要： 目的观察帕金森病(Parkinsons disease, PD)患者与非PD患者丙泊酚诱导意识消失所需的效应室浓度（effect-site concentration, Ce）。方法纳入2022年10月16日至2023年10月14日于首都医科大学附属北京天坛医院就诊的患者,筛选年龄50~80岁，美国麻醉医师协会(American Society of Anesthesiologists, ASA)分级Ⅱ－ Ⅲ级，行双侧脑深部电刺激手术的PD患者（PD组），并按照年龄和性别匹配选取同期行非神经外科非心脏手术的非PD患者（Non-PD组）各37例为研究对象。采用Schnider模型靶控泵注丙泊酚，警觉/镇静观察（Observer’s Assessment of Alertness/Sedation, OAA/S）评分达1分后20 s评估意识状态，采集5 min临床试验数据后停药，记录给药后OAA/S评分1分时、停药后OAA/S评分3分时丙泊酚的Ce、患者状态指数（patient state index, PSI）。结果 PD患者组诱导至无意识状态所需丙泊酚剂量明显少于Non-PD患者组［(2.2±0.4)mg/L vs (3.1±0.4)mg/L，P＜0.05］；与Non-PD患者比较，PD患者意识消失和意识恢复时的PSI值更高（P＜0.05），意识恢复时间明显延长（P＜0.05），意识恢复时丙泊酚Ce更低（P＜0.05）。结论 PD患者诱导意识消失所需的丙泊酚剂量降低，且需要在更低的Ce下苏醒，苏醒时间明显长于非PD患者，在意识消失和苏醒时的PSI均高于非PD患者，麻醉管理中应予以重视。

关键词: 帕金森病, 丙泊酚, OAA/S, 效应室浓度, PSI, 意识消失, 意识恢复

Abstract: Objective To observe the effect-site concentration (Ce) of propofol required for loss of consciousness during induction in patients with Parkinsons disease (PD) and non-PD patients. Methods From October 16, 2022 to October 14, 2023, 37 PD patients (PD group) aged 50－80 years, with American Society of Anesthesiologists (ASA) Ⅱ－Ⅲ, who underwent bilateral deep brain stimulation (DBS) surgery at Beijing Tiantan Hospital, Capital Medical University, were enrolled. Another 37 non-PD patients (Non-PD group), who were age and gender matched with PD patients and underwent non-neurosurgical and non-cardiac surgeries during the same period, were selected as control group. Propofol was administered via target-controlled infusion (TCI) using the Schnider model. The level of consciousness was assessed 20 s after the Observer’s Assessment of Alertness/Sedation (OAA/S) score dropped to 1. The administration of propofol was stopped after 5 mins of clinical trial data collection. The Ce of propofol and patient state index (PSI) were recorded at loss of consciousness (OAA/S=1) and upon recovery of consciousness (OAA/S=3) . Results The dose of propofol required to induce unconsciousness in the PD group was significantly lower than that in the Non-PD group ［(2.2±0.4)mg/L vs (3.1±0.4)mg/L, P＜0.05］. Compared with the Non-PD group, the PD group had higher PSI values both at the time of loss of consciousness and consciousness recovery (P＜0.05), significantly longer consciousness recovery time (P＜0.05), and lower propofol Ce at the time of consciousness recovery (P＜0.05). Conclusion PD patients require a lower dose of propofol to induce loss of consciousness and need to recover at a lower Ce. Their consciousness recovery time is significantly longer than that of Non-PD patients, and their PSI values are higher than those of Non-PD patients both at the time of loss of consciousness and recovery. These characteristics should be taken into account in anesthesia management for PD patients.

Key words: Parkinson's disease, propofol, OAA/S, effect-site concentration, PSI, loss of consciousness, recovery of consciousness

中图分类号:

R614

王进飞, 熊蔚, 王云珍, 于芸, 韩如泉. 帕金森病患者丙泊酚诱导意识消失的效应室浓度[J]. 首都医科大学学报, 2025, 46(6): 1126-1132.

Wang Jinfei, Xiong Wei, Wang Yunzhen, Yu Yun, Han Ruquan. Effect-site concentrations of propofol to induce loss of consciousness in patients with Parkinson's disease[J]. Journal of Capital Medical University, 2025, 46(6): 1126-1132.

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