摘要
目的观察性别对全麻苏醒期靶控输注(TCI)丙泊酚的血药浓度及药效学的影响。方法选择美国麻醉医师协会(ASA)Ⅰ~Ⅱ级进行耳鼻喉科手术的患者18例,按性别分为男性组、女性组,每组9例。麻醉诱导及手术期间用内嵌Marsh药代动力学参数的TCI系统输注丙泊酚镇静,手术结束进入麻醉复苏室即开始梯度降低丙泊酚的目标效应室浓度(C_e),在进入麻醉复苏室后0,10,20,30,60,90,120 min用HPLC法测定血浆药物浓度,比较实测血浆浓度(C_m)与目标血浆浓度(C_p)、C_e的差异,并记录分析患者镇静/警觉评分的差异。结果全麻苏醒期,2组C_m均低于C_p,其中男性组在30 min C_m较C_p显著降低(P<0.05),女性组在10~90 min各时间点C_m较C_p显著降低(P<0.05)。男性组与女性组C_e、C_p差异无统计学意义(P>0.05)。进入麻醉复苏室后0,10 min,女性组C_m分别为(4.37±0.90),(1.71±0.52)μg·m L^(-1),男性组分别为(5.04±0.93),(2.10±0.37)μg·m L^(-1),差异有统计学意义(P<0.05)。女性组和男性组TCI系统偏离性分别为-17.27%和-12.25%,精密度分别为28.01%和22.98%。10~60 min各时间点女性患者镇静/警觉评分偏高于男性患者,但差异无统计学意义(P>0.05),其余时间点2组患者镇静/警觉评分相同。结论全麻苏醒期TCI丙泊酚时女性患者与男性患者相比,Cp与Cm偏差较大,性别因素对血药浓度有明显影响,对药效学影响差异无统计学意义。
Objective To explore the impact of gender on plasma concentration and pharmacodynamics of propofol by target controlled infusion（ TCI） during anesthetic recovery. Methods Eighteen patients（ ASA grade Ⅰ or Ⅱ） who would undergo otolaryngology surgery were enrolled and divided into male group and female group according to gender with 9cases in each group. During the anesthesia induction and surgery period,propofol was infused by TCI system incorporating the Marsh model. After the surgery was finished,the moment the patients entered the post anesthesia care unit,target effect site concentration（ Ce） was gradiently decreased,blood samples were taken at 0,10,20,30,60,90 and 120 min after patients entered the postanesthesia care unit, the plasma concentrations of propofol were determined by HPLC, the difference among measured plasma concentration（ Cm）,target plasma concentration（ Cp） and Cewere compared, and the alertness/sedation scale wassimultaneous assessed. Results The Cmof propofol were lower than Cpat each time points in the two groups during the anesthetic recovery period. The Cmof male group were significantly lower than Cpat 30 min time point（ P〈0. 05）,the Cmof female group were significantly lower than Cpat 10-90 min time points（ P〈0. 05）. There was no statistically significant difference of Ceand Cpbetween the male and female groups（ P〈0. 05）. The Cmof female group were lower than male group at each time point,and there were significant differences at 0,10 min time points between the two groups（ P〈0. 05）. The Cmof female group were（ 4. 37 ± 0. 90）,（ 1. 71 ± 0. 52） μg·m L-1,and the Cmof male group were（ 5. 04 ± 0. 93）,（ 2. 10 ± 0. 37） μg·m L-1at 0,10 min respectively. The median prediction performance error was-17. 27% in female group and-12. 25% in male group,and the median absolute performance error was28. 01% and 22. 98%,respectively. The alertness/sedation scales of female group were higher than male group at10-60 min time points,but there were no significant difference（ P〈0. 05）,the alertness/sedation scales were same at the other time points. Conclusion In the anesthetic recovery period,the deviation between the measured and target plasma concentration of propofol was larger in female than in male,suggesting that gender has significant impact on plasma concentration of propofol,the impact of gender on pharmacokinetics was not significant.
作者
孟冬梅
张雪贞
温晓晖
喻鹏久
肖翔林
MENG Dong - mei ZHANG Xue - zhen WEN Xiao - hui YU Peng - jiula XIAO Xiang - lin(a. Department of Pharmacy b. Department of Anasthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China)
出处
《中国临床药理学杂志》
CAS
CSCD
北大核心
2017年第5期411-414,共4页
The Chinese Journal of Clinical Pharmacology
关键词
丙泊酚
靶控输注
性别
血药浓度
药效学
propofol
target controlled infusion
gender
plasma drug concentration
pharmacodynamics
