摘要
目的 探讨异丙酚靶控输注用于硬膜外麻醉病人清醒镇静的可行性及所需靶控血药浓度。方法５０例在硬膜外麻醉下行下腹部及下肢手术病人，以血浆室为靶控目标，予以异丙酚ＴＣＩ清醒镇静。靶控血药浓度最初设定为０．５μｇ／ｍｌ，在与效应室异丙酚浓度达平衡后３ｍｉｎ以０．１μｇ／ｍｌ递增，直至ＯＡＡ／Ｓ评分降至３分，并抽取病人各时点静脉血３ｍｌ，采用高效液相色谱分析法测定异丙酚血药浓度，确定不同ＯＡＡ／Ｓ评分时对应靶控血药浓度及其与ＢＩＳ相关性，评估靶控输注系统的性能。结果 预期误差的中位数 ＭＤＰＥ＝－２３．１％，预期误差绝对值的中位数 ＭＤＡＰＥ＝２７．６％，清醒镇静深度（ＯＡＡ／Ｓ评分３分）时所需的异丙酚靶控血药浓度为（１．７４±０．１３）μｇ／ｍｌ。ＢＩＳ与ＴＣＩ血药浓度具有良好的相关性（ｒ＝－０．８０，Ｐ＜０．０５）。结论 异丙酚靶控输注用于硬膜外麻醉病人清醒镇静具有可控性良好，病人镇静深度适宜，血液动力学影响小，适用于临床推广。
Objective To investigate the feasibility of target-con trolled infusion (TCI) with propofol for conscious sedation in patients undergoing epidural anesthesia and determine the required target blood concentration.Methods Fifty ASA I - II patients (27 male, 23 female) aged 20-60 years undergoing operation in lower abdomen or on lower extremity under epidural anesthesia were included in this study. The block height was lower than T,. Baseline BIS, SEF, HR, and MAP were measured before epidural anesthesia. Target blood propofol concentration was initially set at 0.5μg·ml-1 . The level of sedation was evaluated using OAA/S scale. New target blood concentration was set at least after 3 min, the delay between blood concentration and concentration at effect site, by increment of 0. 1μg·ml until OAA/ S score was reduced to 3. The target blood propofol concentration at different OAA/S scores was determined and also the correlation between OAA/S and BIS. TCI system consisted of (1) laptop P II (2) Graseby 3500 computerized infusion pump and (3) RS232 connector. Stelpump 1.06P( written by Johan Coetzee) was used for control program, and Marsh pharmacokinetic parameters were used in this study. Blood propofol concentration was measured by high-performance liquid chromatography (HF'LC) .Results The median prediction error (MDPE) was -23.1% . The median absolute prediction error (MDAPE) was 27.6% . The target blood propofol concentration for conscious sedation (OAA/S 3) was (1.74 ?.13)fig' ml'1 . There was a good correlation between BIS and target blood concentration (r= -0.80,P<0.05). Conclusions TCI with propofol for conscious sedation in patients undergoing epidural anesthesia has the advantages of good control, appropriate sedation and less hemodynamic effect and can be used clinically.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2001年第12期711-713,共3页
Chinese Journal of Anesthesiology
基金
湖北省自然科学基金资助项目(99J152)
关键词
二异丙酚
清醒镇静
硬膜外麻醉
靶控输注
Propofol
Conscious sedation
Anesthesia, epidural
Target-controlled infusion
