摘要
目的 分析靶控输注(TCI)异丙酚靶血浆药物浓度与实测浓度的差值,评价TCI系统性能。方法 61例下腹部择期手术患者,ASA Ⅰ～Ⅱ级。微机连接佳士比3500微量泵,选用Stelpump软件内嵌Tackley药代动力学参数。恒定靶血浆药物浓度(3μg·ml^(-1)变速输注持续1h,间断采集动脉血持续1.5h。应用气相色谱-质谱(GC-MS)法测定异丙酚血浆药物浓度。结果 异丙酚输注期间各时点的实测浓度均明显高于靶浓度,停止输注后各时点的实测浓度均明显低于靶浓度(P<0.05)。输注期间TCI系统偏离度(MDPE)为30.02％、精确度(MDAPE)为31.55％、摆动度(wobble)为21.42％、分散度(divergence)为-0.51％/h。停止输注后TCI系统偏离度为19.71％、精确度为21.63％、摆动度为13.29％、分散度为-0.26％/h。结论 国人应用TCI系统输注异丙酚,其靶血浆药物浓度与实测浓度差异明显。系统偏离度和精确度均大于TCI系统性能要求的范围,摆动度偏大。
Objective To determine the difference between target and measured concentrations of propofol given by target - controlled infusion (TCI) and evaluate the performance of the TCI system for Chinese. Methods Sixty-one ASA Ⅰ - Ⅱ patients (26 male, 35 female) aged 20 - 64 yr, undergoing elective lower abdominal surgery were included in this study. Body weight ranged from 43 - 81 kg and height from 143 - 185 cm. Radial artery was cannulated for BP monitoring and blood sampling.The patients were premedicated with intramuscular atropine 0.007 - 0.01 mg·kg-1 and phenobarbital 1 - 2mg·kg-1. Anesthesia was induced with fentanyl 2μg·kg-1 and TCI of propofol of which the target plasma concentration was set at 3 μg·ml-1.Intubation was facilitated with vecuronium 0.1mg·kg-1.Anesthesia was maintained with fentanyl - TCI of propofol - vecuronium. TCI of propofol was maintained for 1 h. The TCI system was composed of DellTM InspironTM 8200 computer, Graseby 3500 infusion pump, Stelpump software (Version 1.07 by JF Coetzee and R Kina) and the pharmacokinetic model and parameters by Tackley.MAP,HR,SpO2 and CVP were monitored throughout anesthesia. Blood samples were taken before induction of anesthesia (To baseline), at 2,5,10,20, 30,40,50,60,62.5,65,70,75,80,90 min after start of TCI (T1-15) for determination of plasma propofol concentration by Gas Chromatography-Mass Spectrometry (GC-MS). Comparing measured with target concentrations the median performance error (MDPE),mean absolute performance error (MDAPE),wobble and divergence were calculated.Results Compared with target concentrations,the measured concentrations of propofol were significantly higher during TCI but lower after TCI.The difference between the target and measured concentrations was significant during T1-15(P<0.05).During 60 min of TCI of propofol MDPE, MDAPE, wobble and divergence were 30.02%,31.55% ,21.4% and -0.51 %·h-1 respectively. During the 30 min after TCI was discontinued,MDPE,MDAPE,wobble and divergence were - 19.71%,21.63%,13.29% and -0.26%·-1 respectively.Conclusion The performance of the TCI system for propofol is not acceptable for clinical application. The pharmacokinetic model and parameters by tackley are unsuitable for Chinese. Further study on the population phannacokinetics of Chinese is needed.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2003年第11期822-825,共4页
Chinese Journal of Anesthesiology
基金
中国博士后科研基金资助[中博基(2002)17号]
