靶控输注丙泊酚期间血药浓度与血液动力学变化关系的探讨  

A study on the relationship between the concentrations of propofol and the changes of hemodynamics during TCI

作　　者：王江[1] 郑宏[1] 曹兴华[1] 

机构地区：[1]新疆医科大学第一附属医院麻醉科,乌鲁木齐市830000

出　　处：《临床麻醉学杂志》2005年第2期90-92,共3页Journal of Clinical Anesthesiology

基　　金：中国博士后科研基金资助项目[中博基(2002)17号]

摘　　要：目的探讨恒定靶浓度变速输注丙泊酚期间血药浓度与血液动力学变化及与意识消失时间的相关性.方法61例择期腹部手术患者,ASAⅠ～Ⅱ级.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持续输注1 h,采样时间1.5 h.应用气-质联机(GC-MS)测定丙泊酚血药浓度.连续监测平均动脉压(MAP)和心率(HR),记录意识消失时间.结果意识消失时间为(2.01±0.53)min.血药浓度达峰时间为2 min,随着输注时间延长,浓度逐渐下降接近靶浓度.血药浓度＞4.59 μg/ml时,MAP由基础值的(93.0±10.2)mmHg降至(72.5±11.7)mmHg,下降幅度为22.1%;血药浓度＜4.45μg/ml时,MAP逐渐恢复到(80.2±11.2)mmHg,但仍较基础值低14.0%.血药浓度＞3.73μg/ml时,HR由基础值的(89.2±13.6)次/分减至(75.4±12.1)次/分,下降幅度为15.5%;而血药浓度＜3.73 μg/ml时,HR逐渐恢复至(77.9±13.8)次/分,较基础值低13.5%.结论靶浓度3μg/ml能提供满意的镇静及气管插管条件;诱导期丙泊酚靶控输注(TCI)的血药浓度和血液动力学变化之间具有密切的相关性.Objective To study the relationship between the concentrations of propofol and the changes of hemodynamics,and the time of lost of consciousness during TCI.Methods Target-controlled infusion of propofol was administered in sixty-one patients,ASAⅠ-Ⅱ,scheduled general operations.Radial artery was cannulated for MAP monitoring and blood sampling.Anesthesia was induced and maintained with propofol,with a single constant target plasma propofol concentration of 3μg/ml.When the patients lost of consciousness,a loading dose of fentanyl 2μg/ml,followed by 2μg/ml,and vecuronium 0.1mg/ml were given When muscle paralysis was satisfactory the endotrachea was intubated.Blood samples were obtained before and 2-60min during and 30min after propofol TCI for determination of blood propofol concentration.The MAP and HR were monitored and recorded at the time of lost of consciousness during anaesthesia.Results The time of lost of consciousness was (2.01±0.53)min.It took 2min to reach the peak of concentration,and gradually declined thenceforwad.When the propofol concentration was more than 4.59μg/ml,MAP declined by 22.1% from the baseline [(93.0±10.2)mmHg].When propofol concentration was more than 3.73μg/ml,HR declined by 15.5% from the baseline [(89.2±13.6)bpm].Conclusion Target concentration of 3μg/ml propofol could provide a satisfactory sedation and good conditions for trachea intubation.Propofol concentration was closely related to hemodynamic change during TCI. [

关 键 词：血药浓度 丙泊酚 血液动力学 靶控输注 相关性 持续输注 气管插管条件 血浆药物浓度 药代动力学参数 择期 

分 类 号：R614[医药卫生—麻醉学]