依托咪酯靶控输注时靶浓度与实测血药浓度的差值分析和系统性能评价  

Analysis of the difference between target and measured plasma concerntrations of etomidate administered by TCI and evaluation of the performance of the TCI system

作　　者：谌雅雨 张兴安[1] 丁立姝 谈晓露 邵伟栋 徐波[1] CHEN Yayu;ZHANG Xing’an;DING Lishu;TAN Xiaolu;SHAO Weidong;XU Bo(Department of Anesthesiology,General Hospital of Southern Theatre Command,Southern Medical University,Guangzhou 510510,China)

机构地区：[1]南方医科大学附属南部战区总医院麻醉科,广州市510510 [2]南昌大学第二附属医院麻醉科

出　　处：《临床麻醉学杂志》2019年第11期1065-1069,共5页Journal of Clinical Anesthesiology

基　　金：广东省科技计划项目(2013B090500113)

摘　　要：目的分析靶控输注(TCI)依托咪酯血浆靶浓度(Cp)0.5μg/ml与实测血浆浓度(Cm)的差异,并评价内嵌Arden药代动力学参数的思路高TCI-Ⅲ型输注系统的性能。方法择期全麻下行颈椎前路或腰椎侧路减压植骨内固定术患者12例,男7例,女5例,年龄19~59岁,BMI 18~29 kg/m^2,ASAⅠ或Ⅱ级。麻醉诱导前将0.5μg/kg右美托咪定10 min恒速泵注完毕,诱导时先以舒芬太尼0.3μg/kg缓慢地静脉注射,设定依托咪酯血浆靶浓度为0.5μg/ml持续泵注,待意识消失后,静脉注入顺式阿曲库铵0.3 mg/kg,行气管插管。麻醉维持期间依托咪酯血浆靶浓度维持0.5μg/ml恒定不变,同时辅以瑞芬太尼、右美托咪定静脉泵注,维持患者BIS 40~60。于依托咪酯TCI前即刻、TCI后1、3、5、10、20、30、60、90、120 min采集桡动脉血样,采用前期试验已验证的超高效液相色谱串联质谱(UPLC-MS/MS)法测定血浆依托咪酯浓度。分析计算TCI依托咪酯的系统性能评价指标,包括精确度、偏离度、摆动度和分散度。结果 TCI后1、3、10 min时,依托咪酯Cm均明显低于Cp(P<0.05),依托咪酯总体血样Cm为0.42μg/ml,明显低于Cp 16%(P<0.05)。输注期间TCI系统的偏离度为-15.9%,精确度为21.9%,摆动度为22.0%,分散度为-0.72%/h。结论 TCI依托咪酯恒定靶血浆浓度(Cp)0.5μg/ml时,内嵌Arden药代动力学参数TCI系统的偏离度和摆动度稍大,但系统分散度小,能维持稳定的血浆浓度,精确度在临床可接受范围内。Objective To analyze the difference between target and measured concentrations of etomidate 0.5 μg/ml administered by target-controlled infusion(TCI) and evaluate the performance of the TCI-Ⅲ system incorporating the Arden pharmacokinetic parameters. Methods Twelve patients, 7 males, 5 females, aged 18-59 years, with a BMI 18-29 kg/m^2, falling into ASA physical status Ⅰ or Ⅱ, undergoing spinal surgery were included in this study. Before anesthesia induction, dexmedetomidine was pumped for 10 min at 0.5 μg/kg, anesthesia was induced with 0.3 μg/kg sufentanil and etomidate at target plasma concentration of 0.5 μg/ml by TCI, after loss of consciousness, cisatracurium 0.3 mg/kg was given to facilitate endotracheal intubation. The anesthesia was maintained with target plasma concentration of etomidate at 0.5 μg/ml,supplemented with remifentanil and dexmedetomidine, maintaining the BIS 40-60. Arterial blood samples were collected before induction of anesthesia at 1, 3, 5, 10, 20, 30, 60, 90, 120 min after start of TCI for determination of plasma etomidate concentration by UPLC-MS/MS verified in previous experiments. The median performance error(MDPE), median absolute performance error(MDAPE), wobble and divergence were calculated to evaluate TCI etomidate system. Results The measured concentrations(Cm)of etomidate were significantly lower than the target plasma concentration(Cp) at 1, 3, 10 min of TCI(P<0.05). The overall sample mean of etomidate Cm was 0.42 μg/ml, which was significantly lower than Cp 16%(P<0.05). The MDPE, MDAPE, wobble and divergence were-15.9%, 21.9%, 22.0% and-0.72%/h. Conclusion The MDPE and wobble of the TCI system incorporating the Arden pharmacokinetic parameters were slightly larger when the target plasma concentration of etomidate was set at 0.5 μg/ml, but the system has low divergence and can maintain stable blood concentration.

关 键 词：依托咪酯 药物释放系统 评价研究 

分 类 号：R61[医药卫生—外科学]