全麻诱导期间以不同速度输注异丙酚动静脉血药浓度的变化  

Changes of arterial and venous blood propofol concentrations at different infusion rates during anesthesia induction

作　　者：盖成林[1] 古妙宁[1] 林春水[1] 欧阳铭文[2] 王玉珍[1] 周俊岭[3] 安胜利[4] 

机构地区：[1]第一军医大学南方医院麻醉科,广东广州510515 [2]第一军医大南方医院麻醉科,广东广州510515 [3]第一军医大学中心实验室,广东广州510515 [4]第一军医大学医学统计学教研室,广东广州510515

出　　处：《第一军医大学学报》2001年第5期348-350,共3页Journal of First Military Medical University

基　　金：广东省医学科研课题基金!(A2000393)

摘　　要：目的　探讨患者意识消失时的异丙酚血药浓度与给药速度的关系。方法ＡＳＡＩ～Ⅱ级无心、脑、肝、肾功能异常的择 期手术患者２１例，随机分为Ａ、Ｂ、Ｃ组，静脉注射异丙酚，速度分别为６、９、１２ｍｇ·ｋｇ－１·ｈ－１，持续３０～３５ｍｉｎ。给药后于不 同时点同步采取桡动脉及颈内静脉球部血样，以高效液相色谱－荧光法检测异丙酚的血药浓度。结果Ａ、Ｂ、Ｃ组患者意 识消失时的异丙酚用量分别为１．１５、１．１０和１．２０ｍｇ／ｋｇ·ｂ．ｗ，无统计学差异，而平均诱导时间分别为６９７、４４１和３１３ｓ， 差异显著（Ｐ＜０．０５）。意识消失时平均动脉血药浓度（Ｃａ）分别为１．６４、２．２４和２．７８ｍｇ／Ｌ，统计学差异显著（Ｐ＜０．０１）；平均 颈内静脉球部血药浓度（Ｃｉｊｂｖ）分别为ｌ．１８、ｌ．４０和ｌ．６９ ｍｇ／Ｌ，仅Ａ、Ｃ组间有统计学差异（Ｐ＜０．０５）。从开始输注到意识 消失时Ａ、Ｂ、Ｃ组的动静脉血药浓度－时间曲线下面积（ＡＵＣａ－ｖ）分别为４．５６、４．６４和４．２３ ｍｇ·Ｌ－１·ｍｉｎ－１，无显著性差异。 结论　意识消失时的动脉和静脉血药浓度与给药速度有关；非稳态条件下异丙酚的靶血浆浓度并不能预测患者意识消失。Objective: To study the relationship between the plasma concentrations of propofol in unconscious patients and the injection speed of the drug. Methods Twenty-one ASA Class I to Ⅱ patients, scheduled for elective operations, were randomly divided into 3 groups (A, B and C) to receive a constant propofol administration at 6, 9 and 12 mg .kg-1 h-l respectively for 30 min. Propofol concentrations were analyzed from simultaneous arterial and jugular bulb venous blood samples using high-pressure liquid chromatography-fluorescence detector. Results There were no significant differences in the total dose of propofol administered till the loss of conscious (1. 15, 1. 10 and 1 .20 mg/kg bw). However there were significant differences between the groups in the mean induction time (697, 441 and 313 s,P＜0.05 ), and in mean arterial and venous concentrations during induction. Concentrations of propofol were 1 .64, 2.24 and 2.78 mg/L (P<0.01) in arterial blood arterial blood and 1. 18, 1 .40 and l.69 mg/L (P＜0.05,only between group A and C) in the venous blood. There were no significant. differences between the groups in the area under the arterial and venous time concentration curves from the start of induction to the loss of consciousness (AUCa-v, 4.56, 4.64 and 4.23 mg .L-1 min-l). Conclusions Both arterial and venous blood propofol concentrations at loss of consciousness depend on the rate of administration. A target blood concentration of propofol can not be identified with loss of consciousness under unstable conditions.

关 键 词：二异丙酚 全身麻醉 血药浓度 静脉内输注 

分 类 号：R614.2[医药卫生—麻醉学]