硬膜外麻醉时血浆局麻药浓度的预测  

Estimating really plasma concentrations of local anesthetics for epidural anesthesia

作　　者：江学成[1] 卢建丰[2] 文小兵 周文[1] 徐德朋[1] 张育才[1] 胡宁利[1] 

机构地区：[1]解放军第九七医院麻醉科,徐州市221004 [2]南京军区南京总医院药剂科

出　　处：《临床麻醉学杂志》2004年第9期529-531,共3页Journal of Clinical Anesthesiology

摘　　要：目的　实时和快速预测硬膜外腔给药时血浆局麻药浓度 ,预防局麻药中毒。方法　体内药量的实时变化用微积分、Laplace转换和逆转换等方法推导浓度 时间方程。以VFP 6 0制作“硬膜外麻醉血药浓度实时预测”程序。在 2 8例硬膜外麻醉病人中分别推注 (1ml/ 3s)和泵注 (1ml/min) 2 %利多卡因 15ml,于给药后 3、6、9、12、15、18、2 1、30、6 0、90min抽静脉血 ,以高效液相法测定利多卡因浓度 ,并将预测值与临床结果进行拟合。结果　推导出硬膜外腔推注和输注给药、单剂量和多剂量给药、推注和输注混合给药等多种给药方式的数学模型。根据这些模型制作的计算机软件 ,能够实时和快速预测病人血浆局麻药水平 ,预测结果与临床结果没有统计学差异 (P >0 5 )。结论　该程序能较方便准确地实时和快速预测硬膜外腔给药时血浆局麻药浓度 。Objective To predict plasma concentrations of local anesthetics during continuous epidural infusion.Methods Using the laplace transform and the anti-laplace ransform methods,pharmacokintic models of local anesthetics during epidural anesthesia were established.On those models,“the system of predicting plasma concentrations of local anesthetics for epidural anesthesia”was programmed with Visual FoxPro 6.0 and running on Windors 95 or later.Initial volumes of 15 ml of 2% plain lidocaine at a rate of 1 ml/3 seconds or 1 ml/min were respectively injected into the epidural space through the epidural catheter in 28 patients.Venous blood samples of 3 ml were drawn for measurement of the lidocaine concentration at 3,6,9,12,15,18,21,30,60,90 min after epidural administration by a high-pressure liquid chromatographic technique.We fit clinical results with predicting value.Result The software is easily learned and used,it can rapidly,really and accurately predicts blood local anesthetic level.Conclusion The system can rapidly,really and accurately estimate blood local anesthetic level in patients undergoing epidural blockade,benefitial to the option of dose and infusion rate of local anesthetics and avoiding systemic toxity.

关 键 词：硬膜外麻醉 局麻药 血药浓度 预测 

分 类 号：R614[医药卫生—麻醉学]