硬膜外麻醉下靶控输注丙泊酚镇静对血流动力学的影响  

The Effect of Sedation with Target-controlled Infusion Propofol on Heamodynamics During Epidural Anesthesia

作　　者：彭玉梅[1] 顾丽莉[1] 

机构地区：[1]江苏省无锡市第三人民医院麻醉科,214041

出　　处：《中国微循环》2005年第6期425-427,共3页Journal of Chinese Microcirculation

摘　　要：目的观察不同药代学参数靶控丙泊酚输注系统镇静时,对硬膜外麻醉患者血流动力学的影响,并确定血压降低50%的靶控浓度.方法 26例择期行硬膜外麻醉手术的病人,ASAⅠ～Ⅱ ,术中分别采用内嵌Marsh(M组)和Shafer(S组)丙泊酚药代学参数的TCI系统镇静,靶浓度从0.4 μg/ml开始,以0.4 μg/ml梯度逐渐上升,直至患者入睡,每个靶控浓度至少维持15 min以上.观察并记录收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)和脉搏氧饱和度(SpO2)和镇静警醒(OAA/S)评分.结果 MAP随靶控浓度的升高而降低,M组和S组MAP最大降低幅度分别为17%和26%,MAP降低50%的靶控浓度分别为7.3 μg/ml和4.5 μg/ml.结论硬膜外麻醉下靶控输注丙泊酚镇静时,达意识消失状态时的靶控浓度远低于EC50,镇静深度易于调控,血液动力学较稳定.但Shafer参数TCI系统对血流动力学的影响较大.Objective To observe the effect of target controlled intravenous infusion of propofol with different pharmacokinetic parameter sets on the hemodynamics during epidural anesthesia and determine the EC50s of target-controlled concentration. Methods Twenty-six patients, ASA grade Ⅰ-Ⅱ, received TCI propofol with pharmacokinetic parameter set reported by Marsh （ group M, n = 13） and Shafer （ group S, n = 13） beginning with 0.4μg/ml, increment of 0.4μg/ml until the patients lose consciousness. Every target- controlled concentration maintained at least 15 minutes. SBP,DBP,MAP,HR,SpO2 and OAA/S were recorded for all patients at the end of given target-controlled concentration. Results MAP decreased gradually along with increasing of target-controlled concentration. The decreased range of MAP was 16% and 27% in group M and group S reapectively. The ECso of target-controlled concentration of propofol for MAP was 7.3μg/ml and 4.5μg/ml in group M and group S. Conclusion Target-controlled concentration of propofol for sedation is far lower than ECho no matter what pharmacokinetic parameter sets are used during epidural anesthesia. It can maintain stable blood pressure and adjust depth of sedation accurately. Sedation used TCI system with Shafer parameter set has greater effect than that with Marsh parameter set on hemodynamics.

关 键 词：丙泊酚 麻醉 药物投与系统 输注 镇静 

分 类 号：R614.42[医药卫生—麻醉学]