瑞芬太尼Minto药动学参数在老年患者靶控输注应用中的评价

Target Controlled Infusion of Remifentainil in Elderly Patients:Assessment of Predictive Performance of Minto Parameters

目的:研究瑞芬太尼TCI-Ⅰ型靶控输注系统(Minto药代动力学参数)在老年患者中应用的可行性,并评价TCI系统性能。方法:15例择期手术老年患者,ASAⅠ或Ⅱ级,年龄65～75岁,体重50～71 kg。桡动脉穿刺进行BP监测和采集血样,锁骨下静脉穿刺进行药品和液体输注。瑞芬太尼(血浆靶浓度5 ng·ml-1)靶控输注30 min。实验过程中维持瑞芬太尼的靶浓度不变。TCI开始后1 min、3 min、5 min、10 min、15 min、20 min、25 min、30 min采集桡动脉血,用HPLC-UV测定瑞芬太尼血浆药物浓度;采用执行误差(PE)、PE的中位数(MDPE)、PE绝对值的中位数(MDAPE)及摆动度来评价TCI系统的性能。结果:瑞芬太尼实测血浆浓度各时间点比较无统计学差异(P>0．05);与靶浓度相比,瑞芬太尼实测血浆浓度均显著降低(P< 0．05)。Minto群体药代动力学参数应用于国人老年患者的靶控输注时,MDPE、MDAPE、Wobble分别是16．80％、23．85％和11．29％。结论:瑞芬太尼Minto药代动力学参数可以在国人老年患者TCI系统中应用,系统稳定后,虽然其实测血浆浓度低于预测靶浓度,但系统的偏离度、精确度均在TCI系统性能要求范围内,适合老年患者靶控输注。

Objective：To evalutate the performance of the target-controlled infusion system for remifentanil using minto phar- macokinetic parameters in Chinese old patients. Methods：Fifteen ASA Ⅰ -Ⅱ patients aged 65-75yr,body weight ranged from 50-71 kg, scheduled for surgery were enrolled in this study. The patients were unpremidicated. Left radial atery was cannulated for BP monitoring and blood sampling, right subclavian vein was cannulated for drug and fluid administration, remifentanil （5 ng · mL^-1 ）was given by TCI for 30 min. BIS,MAP, HR and SPO2 were continuosly monitored during the experiment. Blood samples were taken at 1, 3,5,10,15,20,25,30min after the start of TCI for determination of blood remifentanil concentraion by HPLC-UV（Waters600）. The performance were caculated by the median performance error（MDPE）, the median absolute performance error（MDAPE）and Wobble. Results： the measured concentrations of remifentanil were significant lower than the predicted concentration during the experiment（P〈0.05）. When remifentanil TCI system （the pharmacokinetic set described by Minto ）was steady ,the MDPE .MDAPE and Wobble were 16. 80%, 23.85 % and 11.29%, respectively. Conclusion： Though the measured remifentanil concentration is overpredicted by the TCI system incorporating Minto pharmacokinetic parameter , the performance is acceptable in Chinese old patients.