急性等容血液稀释对髋关节置换术病人靶控输注异丙酚药代动力学的影响  

Effect of acute normovolemic hemodilution on the pharmacokinetics of propofol by TCI during hip joint replacement

作　　者：郑宏[1] 王江[1] 宣燕[1] 张冰[1] 芮建中[2] 刘进[3] 

机构地区：[1]新疆医科大学第一附属医院麻醉科,乌鲁木齐830000 [2]南京军区南京总医院临床药理科 [3]四川大学华西医院麻醉科

出　　处：《中华麻醉学杂志》2006年第5期428-431,共4页Chinese Journal of Anesthesiology

摘　　要：目的探讨急性等容血液稀释(ANH)状态下靶控输注(TCI)异丙酚药代动力学的变化。方法择期行髋关节置换术病人35例,ASA Ⅰ或Ⅱ级,预计出血量在1 000 ml,随机分为稀释组(n= 17,ANH平稳后10 min行TCI)和对照组(n=18,未实施ANH直接行TCI)。麻醉诱导后10 min实施 ANH,目标红细胞压积(Hct)为0．26,平稳10 min后以血浆靶浓度(3μg·ml-1)输注异丙酚60 min,间断采血180 min,用气相色谱-质谱法测定异丙酚血药浓度。运用NONMEM软件估算异丙酚TCI药代动力学参数。结果两组一般情况和异丙酚输注总量差异无统计学意义(P>0．05);与对照组比较,稀释组TCI期间异丙酚血药浓度降低,各房室间分布速率常数(K21)减慢,中央室分布容积、周边室分布容积增加(P<0．05),异丙酚药代动力学特征符合二室开放型模型。结论 ANH使TCI异丙酚的中央室和周边室分布容积增加,周边室向中央室的转运速率减慢。Objective To investigate the effect of acute normovolemie hemodilution （ANH） on the pharmacokinetics of propofol administered by target controlled infusion （ TCI ） during hip joint replacement. Methods Thirty-five ASA Ⅰ or Ⅱ patients aged 20-60 yrs weighing 45-77 kg undergoing elective hip joint replacement with an anticipated intra-operative blood loss of more than 1 000 ml were randomized into 2 groups： ANH group （n = 17） and control group （n = 18）. ANH was performed after induction of anesthesia by withdrawing blood from artery until Hct was reduced to 26%. Blood volume was maintained by simultaneous intravenous infusion of lactated Ringer＇s solution （LR） and 6% HES. ANH was completed in 30 min. TCI of prepofol was started 10 min after ANH and maintained for 60 min. The target plasma propofol concentration was set at 3 μg·ml^-1. The TCI system consisted of a Graseby 3500 infusion pump controlled by Stelpump 1.07 software （Stellenbosch University South Africa） using the pharmacokinetic parameters published by Tackley. Arterial blood samples were taken at 2, 5, 10, 20, 30, 40, 50, 60, 80, 100, 120, 150 and 180 min after TCI of prepofol was started for determination of plasma prepofol concentration by gas chromatography-MASS spectrometry （GC-MS）. Pharmacokinetic parameters were assessed using NONMEM software. Results The pharmacokinetic profile of prepofol administered by TCI during ANH was best described by a two-compartment open model. V1 and V2 increased while the rate of transfer from peripheral compartment to central compartment decreased as compared with the control group. Total plasma protein and plasma albumin decreased. Conclusion The distribution volume of central and peripheral compartment increases and transfer rate from peripheral compartment to central eomparent decreases during ANH.

关 键 词：血液稀释 二异丙酚 药物释放系统 药代动力学 

分 类 号：R614[医药卫生—麻醉学]