失血对丙泊酚靶控输注时血药浓度和听觉诱发电位指数的影响  

Effect of blood loss on plasma concentration and auditory evoked potential index of propofol target controlled infusion

作　　者：张小光[1] 杨改生[2] 

机构地区：[1]河北北方学院研究生院,河北张家口075000 [2]中国人民解放军空军总医院麻醉科,北京100142

出　　处：《中国临床药理学杂志》2015年第18期1828-1830,共3页The Chinese Journal of Clinical Pharmacology

基　　金：北京市科技计划基金资助项目(Z141100002114010)

摘　　要：目的 观察术中失血对丙泊酚靶控输注（TCI）时血浆药物浓度（cm）及听觉诱发电位指数（AAI）的影响。方法 选择美国麻醉医师协会（ASA）Ⅰ~Ⅱ,拟行择期骨科脊柱手术的患者108例,按术中失血量分为3组。A组：失血量≤300 m L,B组：300 m L〈失血量≤600 m L,C组：失血量〉600 m L。3组麻醉诱导和维持均使用丙泊酚靶控输注,同时进行听觉诱发电位麻醉深度监测。在丙泊酚麻醉开始后5（T1）,30（T2）,60（T3）,120（T4）,180（T5）,240 min（T6）测定丙泊酚血药浓度（cm）,并记录血液动力学变化和AAI,评价丙泊酚靶控输注的性能。结果 T4-T6时点C组失血量明显大于A、B组（P〈0.01）,B组大于A组（P〈0.05）;补液量C组明显高于A、B组（P〈0.01）,B组高于A组（P〈0.05）。C组较A、B组平均动脉压（MAP）在T5、T6时点明显降低（P〈0.05）。3组T3、T4血药浓度较T1明显下降（P〈0.05）,T5、T6较T1下降更显著（P〈0.01）;C组T4、T5、T6血药浓度较A组明显下降（P〈0.05）。C组T6时丙泊酚靶控系统偏离度为-17.74%。结论 丙泊酚靶控输注时失血会引起实际血药浓度明显低于设定的靶浓度,根据AAI监测实时调整靶浓度是维持麻平稳和血液动力学稳定的重要方法。Objective To investigate the effect of blood loss on plasma concentration and auditory evoked potential index （AAI） of propofol tar- get controlled infusion. Methods One hundred and eight patients（ASA grade I or II ） who were given surgical operation were randomly divided into three groups： group A, blood loss ≤ 300 mL; group B, 300 mL 〈 blood loss≤600 mL; group C, blood loss 〉600 mL. In three groups, in- duction and maintenance of anesthesia were performed by propofol target controlled infusion, simultaneous auditory evoked potential monitoring the depth of anesthesia. Arterial blood samples were taken at anesthetize 5 （T1）,30 （ T2 ）,60 （ T3 ）, 120 （ T4 ）, 180 （ T5 ）,240 min （ T6 ）, and at the same time, the changes of hemodynamics and auditory evoked potential index（AAI） were recorded for evaluating the performances of TCI sys- tems. Results In the duration of T4 - T6 , the blood loss in group C was significantly higher than group A and B（ P 〈 0.01 ） , group B higher than group A （ P 〈 0.05 ） ; and the volume of fluid infusion of group C was sig- nificantly higher than group A and B （ P 〈 0.01 ） , group B higher than group A （ P 〈 0.05 ）. The MAP of group C decreased more than group A and group B （ P 〈 0. 05 ） in the duration of T5 - T6. The plasma concentration of T3 and T4 were lower than T1 （ P 〈 O. 05 ） ; T5 and T6 significant decreased than T1 （ P 〈 0.01 ）, group C was lower than group A （ P 〈 0.05 ） in the duration of T4 - T6. The MDPE was 17.74% of group C in T6. Conclusion Blood loss can cause the actual plasma concentration of propofol below than target concentra- tion. According to AAI monitoring to regulate target propofol concentration can maintain stable vital signs.

关 键 词：丙泊酚 靶控输注 失血 血药浓度 听觉诱发电位指数 

分 类 号：R971.2[医药卫生—药品] R614[医药卫生—药学]