摘要
目的比较瑞芬太尼血浆靶浓度(Cp)6、8 ng·ml-1 复合异丙酚靶控输注(TCI)时瑞芬太尼Cp和实测血药浓度(Cm)的差异,并评价思路高TCI-Ⅰ型系统(Minto药代动力学参数)的性能。方法择期行肺叶或肺段切除术病人36例,ASA Ⅰ或Ⅱ级,年龄40-60岁,体重50-70kg,随机分为2 组,组18例。麻醉诱导:Ⅰ、Ⅱ组瑞芬太尼血浆靶浓度分别为6、8 ng·ml-1,异丙酚效应室靶浓度为3 μg·ml-1,待病人意识消失后静脉注射维库溴铵0.1 mg·kg-1,3 min后行气管插管。麻醉维持:两组瑞芬太尼Cp保持不变,调节异丙酚靶浓度,维持脑电双频指数(BIS)45-55,间断静脉注射维库溴铵维持肌松。分别在瑞芬太尼TCI前及TCI 5、10、20、40、60、90、120 min时用高效液相色谱法测定瑞芬太尼Cm。采用执行误差(PE)、PE的中位数(MDPE)、PE绝对值的中位数(MDAPE)及摆动度评价TCI系统的性能。结果在TCI 5、10、20 min时,两组瑞芬太尼Cm均低于Cp(P<0.05)。Ⅰ、Ⅱ组瑞芬太尼总体血样瑞芬太尼Cm分别为5.1、6.9 ng·ml-1,均低于Cp(P<0.05)。Ⅰ、Ⅱ组MDPE、MDAPE、摆动度分别为-17.2%、29.6%、15.1%和-15.5%、27.8%、12.5%,组间比较差异无统计学意义(P>0.05)。结论瑞芬太尼Cp为6、8 ng·ml-1在国人TCI时,思路高TCI-Ⅰ型系统(Minto药代动力学参数)的精确度在临床可接受范围内,其Cm比Cp低约15%。
Objective To determine the difference between target and measured concentration of remifentanil given by target-controlled infusion （TCI） and evaluate the performance of a new type Ⅰ TCI system for Chinese. Methods Thirty-six ASA Ⅰ or Ⅱ patients aged 40-60 yr weighing 50-70 kg undergoing elective lung resection were randomly divided into 2 groups according to target remifentanil concentration, group Ⅰ 6 ng·ml^-1 and group Ⅱ 8 ng·ml^-1. The patients were premedicated with intramuscular midazolam 0.05 mg·kg^-1 and atropine 0.5 mg. Anesthesia was induced with remifentanil and propofol both given by TCI. The target concentration of propofol （effect-site concentration） was set at 3 μg·ml^-1 and remifentanil （plasma concentration） at 6 or 8 ng·ml^-1. When the patients lost consciousness, vecuronium 0.1 mg·kg^-1 was given i.v. to facilitate intubation. The patients were mechanically ventilated and PET CO2 was maintained at 30-40 mm Hg. Anesthesia was maintained with TCI of propofol and remifentanil and intermittent i.v. boluses of vecuronium. Target plasma concentration of remifentanil remained unchanged during anesthesia. BIS value was maintained at 45-55 by modifying target propefol concentration. Arterial blood samples were taken before and 5, 10, 20, 40, 60, 90 and 120 min after TCI remifentanil was started for determination of blood remifentanil concentration by high performance liquid chromatography. The performance error （PE） was determined for each measured blood remifentanil concentration. The performance in the population was determined by median absolute performance error （MDAPE）, median performance error （MDPE） and the wobble （the median absolute deviation of each PE from the MDPE）. Results The measured concentrations （Cm） of remifentanil were significantly lower than the target plasma concentration （Cp） at 5, 10, 20 rain of TCI in both groups （P〈0.05）. But there was no significant difference between the Cm and Cp at 40, 60, 90 and 120 min of TCI in both groups. The median Cm of all blood samples was 5.1 ng·ml^-1 in group I and 6.9 ng·ml^-1 in group Ⅱ respectively and was significantly lower than Cp （P〈0.05）. The MDPE, MDAPE and wobble were -17.2%, 29.6% and 15.1% in group Ⅰ and -15.5%, 27.8% and 12.5% in group Ⅱ. Conclusion The MDAPE of the new type Ⅰ TCI system incorporating the remifentanil pharmacokinetic set of Minto was clinically acceptable for Chinese people when the target plasma concentration was set at 6 and 8 ng·ml^-1. The Cm was significantly lower than the Cp by approximately 15 % at the beginning of TCI.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2005年第9期645-648,共4页
Chinese Journal of Anesthesiology
基金
河北省科技厅资助项目(042761490)
