快速输注羟乙基淀粉130/0.4对靶控输注中异丙酚血浆浓度的影响  

Effect of a rapid infusion of hydroxyethyl starch 130/0.4 on plasma concentration of propofol in target-controlled infusion

作　　者：肖航[1] 孟杰[1] 陈丽[1] 

机构地区：[1]湖北省孝感市中心医院麻醉科,湖北孝感432000

出　　处：《中国生化药物杂志》2016年第8期119-123,共5页Chinese Journal of Biochemical Pharmaceutics

摘　　要：目的探讨快速输注晶体和胶体对靶控输注异丙酚血浆浓度（Cp）的影响。方法 36例接受胃肠道外科手术的患者随机分成3组（n=12）,输注异丙酚至少30 min后,前20 min,羟乙基淀粉溶液组（HES组）给予24 m L/（kg·h）羟乙基淀粉溶液,醋酸钠林格注射液组（AR组）给予24 m L/（kg·h）醋酸钠林格注射液,HES组、AR组后20 min、对照组全程给予2 m L/（kg·h）醋酸钠林格注射液。每2.5 min测量1次异丙酚的血浆浓度作为原始数据,脉冲染料密度分析仪检测心输出量、血容量及吲哚菁绿清除率,以此计算有效肝血流量（effective hepatic blood flow,EHBF）。结果 Cp比率值随时间变化中,重复测量方差分析显示显著的组（F[2,33]=14.14,P〈0.001）及时间（F[16,528]=10.37,P〈0.001）的效应,以及明显的组和时间的交互作用（F[32,528]=2.82,P〈0.001）。当比较不同组之间的Cp比率时,HES组的Cp比率明显低于AR组（5~40 min）及对照组（10~40 min）,差异均有统计学意义（P〈0.05）。EHBF值随时间变化中,主要组效应：F[2,28]=3.68,P=0.038;主要时间效应：F[2,56]=5.37,P=0.007;组及时间交互作用：F[4,56]=3.67,P=0.010）。其他组的EHBF值在研究过程中均未观察到显著改变。结论快速输注羟乙基淀粉能提高有效肝血流量,从而使靶控输注异丙酚血浆浓度降低。由于快速输注羟乙基淀粉能够降低麻醉深度,故在临床麻醉中应慎用。Objective To investigate the effects of rapid colloid and crystalloid infusions on the plasma concentration of propofol（ Cp） during targetcontrolled infusion. Methods Thirty-six patients were randomly assigned to three interventions（ 12 patients per group）. At least 30 min after the start of propofol infusion,the hydroxyethyl starch solution group（ HES） received HES of 24 m L /（ kg · h）,on the former 20 min,the sodium acetate Ringer＇s injection group（ AR） received AR of 24 m L /（ kg·h）,while HES group and AR group of later 20 min and the control group of whole course received AR of 2 m L /（ kg· h）. The plasma concentrations of propofol were recorded per 2 min and a half. The cardiac outputting,blood volume and clearance of indocyanine green were measured by pulsed dye density analyzer,the effective hepatic blood flow（ EHBF） were obtained. Results The varying of Cp with time showed a significant treatment factor（ F[2,33]= 14. 14,p〈0. 001） and time factor（ F[16,528]= 10. 37,p〈0. 001） and interaction between the above factors（ F[32,528]= 2. 82,p〈0. 001） by ANOVA for repeated measurement; the difference of Cp among each group,Cp in HES group was significantly lower than AR group（ 5-40 min） or control group（ 10-40 min）,with significant difference（ p〈0. 05）. The varying of EHBF with time showed a significant treatment factor（ F[2,28]= 3. 68,P = 0. 038） and time factor（ F[2,56]= 5. 37,P = 0. 007） and interaction between the above factors（ F[4,56]= 3. 67,P = 0. 010）; while there was no significant difference in other groups. Conclusion Rapid HES infusion increases the effective hepatic blood flow,resulting in a decrease of propofol concentration during target-controlled infusion. Rapid HES infusion should be used cautiously as it may decrease the depth of anesthesia.

关 键 词：异丙酚 靶控输注 羟乙基淀粉溶液 醋酸钠林格注射液 

分 类 号：R614.2[医药卫生—麻醉学]