黄疸对丙泊酚效应位消除速率常数的影响  

The influence of jaundice on ke0s of different effect-sites

作　　者：宋金超[1] 张马忠[2] 孙玉明[1] 李泉[1] 杨立群[1] 俞卫锋[1] 

机构地区：[1]第二军医大学附属东方肝胆外科医院麻醉科,上海市200433 [2]上海交通大学医学院附属上海儿童医学中心麻醉科

出　　处：《临床麻醉学杂志》2011年第2期112-115,共4页Journal of Clinical Anesthesiology

基　　金：国家自然科学基金资助项目(30901394)

摘　　要：目的探讨黄疸对丙泊酚效应位靶控输注(TCI)的效应位消除速率常数(ke0)的影响。方法 24例普通胆道手术患者根据胆红素高低分为三组:轻度黄疸组(A组),中重度黄疸组(B组),对照组(C组),每组8例。用Graseby3500泵从颈内静脉分别以1、2、3μg/ml三个梯度行效应位TCI丙泊酚,每个梯度持续12min,在TCI开始或改变浓度后的第6、8、10、12分钟共4个时点各取桡动脉血2ml。ke0根据"S"最大效应曲线计算。结果 A、B、C三组患者脑电双频指数(BIS)的ke0分别为0.582±0.491、0.549±0.181、0.502±0.112,MAP的ke0分别为0.235±0.343、0.161±0.099和0.276±0.198,MAP的ke0三组均显著小于BIS的ke0(P<0.05)。结论黄疸不影响效应位TCI丙泊酚的ke0。以BIS为效应的ke0显著大于MAP的ke0,即BIS效应比MAP效应出现快。Objective This study was to determine the ke0 of different effect-site of propofol and to investigate the influence of jaundice on these parameters. Methods Twenty- four patients were divided into three group： Control group （serum total bilirubin ≤17.1μmol/L, n=8） ; Light-jaundice group （17.1μmol/L〈TBL≤171. 1 μmol/L, n=8）; Middle and heavy jaundice group（TBL〉171.1μmol/L, n = 8）. A target-controlled infusion was used to rapidly attain and maintain three sequentially increasing effect-compartment propofol concentration from 1 to 3μg/ml in all patients. Each target concentration was maintained for about 12 minutes. After the beginning （or on choosing a new target concentration） of propofol, samples （2 ml） were collected at 6, 8, 10 and 12 rain. Bispectrai index （BIS） and mean artcrial pressurc （MAP） were recorded continuously as measures of propofol effect. Ke0 were eslimated by fitting a sigmoid curve. Results The Ke0 s of BIS are 0. 502/min, 0, 582/rain and 0. 549/rain in Control group, Light jaundice group, Middle and heavy- jaundice group; the ke0 of MAP were 0. 276/min, 0. 235/min and 0. 161/rain in three groups. Jaundice has no effect on ke0, s, whereas there is significantly difference between ke0 s of MAP and ke0 s of BIS in each group （P〈0.05）. Conclusion Jaundice has no effect on the ke0 s of different effect-site. The effect of propofol on BIS occurs more rapidly than its effect on MAP.

关 键 词：黄疸 丙泊酚 靶控输注 效应位消除速率常数 药效动力学 

分 类 号：R614[医药卫生—麻醉学]