心肺转流血液稀释对靶控输注丙泊酚血药浓度的影响  

Effect of acute hemodilution on by the CPB plasma concentration of TCI propofol

作　　者：金鑫[1] 陶国才[1] 崔健[1] 顾健腾[1] 易斌[1] 

机构地区：[1]第三军医大学西南医院麻醉科,重庆市400038

出　　处：《临床麻醉学杂志》2008年第7期557-559,共3页Journal of Clinical Anesthesiology

基　　金：第三军医大学临床研究专项基金(项目编号:SWH2005B008)

摘　　要：目的观察心肺转流（CPB）血液稀释对靶控输注（TCI）丙泊酚血药浓度（Cm）的影响。方法14例ASAⅡ～Ⅳ级择期行双瓣置换术患者，诱导后10min静脉TCI丙泊酚靶浓度（Cp）2μg／ml，CPB后输注4％琥珀酰明胶实施血液稀释，于血液稀释前（T0）、血液稀释后3min（T1）、8min（T2）、15min（T3）采集动脉血2ml，采用高效液相色谱-荧光法测定丙泊酚Cm，同时测定Hb和血细胞比容（Hct）。结果T1～T3时的Hb和Hct较T0时明显降低（P〈0．01），并且以上各时点Cm均明显低于T0时（P〈0．05）；而血液稀释后各时点之间丙泊酚Cm比较差异元统计学意义。结论CPB后的急性血液稀释导致丙泊酚Cm明显下降。稀释前实测丙泊酚Cm高于TCI系统机设血浆Cp，而稀释后的Cm均低于Cp。为达到理想Cp，血液稀释后应该加大丙泊酚的用量。Objective To investigate the effect of acute hypervolemic hemodilution （AHH） on plasma concentration of TCI propofol. Methods Fourteen ASA class Ⅱ toⅣ patients were enrolled in this study. Anesthesia was maintained by TCI propofol 10 min after induction. The target plasma concentration of propofol（Cp） was set at 2 μg/ml. At the beginning of CPB, 4% gelofusine was infused simultaneously. Arterial blood samples were taken before hemodilution（T0 ）, and at 3 min （T1） ,8 min（T2 ）, 15 min（T3 ） after it for determination of plasma concentration（Cm） of propofol by HPLC. Hct and Hb were also checked at the same time. Results After hemodilution, Hb was significantly reduced from initial （139.86±19.90） g/L to （82.71±12.86） g/L and Hct from （40.62 ±4.09） % to （25.14 ± 3.82） %, respectively （P〈0.01）. The Cm of propofol was significantly lower at T1. T2 and T3 than that at To （P〈0.05）. There was no significant difference in Cm among T1. T2and T3. Conclusion AHH in CPB decreases the blood concentration of propofol obviously. And it turnes down dramastically at T1. Before AHH, Cm is higher than Cp, but Cm is lower than Cp after AHH. The Cp needs to be increased during AHH of CPB in order to keep a proper depth of anesthesia.

关 键 词：心肺转流 血液稀释 靶控输注 丙泊酚 

分 类 号：R614[医药卫生—麻醉学]