静吸复合麻醉中瑞芬太尼靶控输注系统的性能评价

An Evaluation of the Performance of Remifentanil Target-Controlled Infusion System Under Inhalation and Intravenous Anesthesia

目的评价腹腔镜手术病人静吸复合麻醉中瑞芬太尼靶控输注系统(Minto药代动力学参数)的性能。方法15例择期行腹腔镜手术,采用血浆靶控输注瑞芬太尼、吸入异氟烷和间断静脉注射维库溴铵维持麻醉。瑞芬太尼血浆目标浓度逐渐升高,每次浓度改变间隔时间30 min,目标浓度分别为3、6、9 ng/ml。于麻醉诱导前(空白对照血浆)和瑞芬太尼目标浓度改变后30 min时从桡动脉置管处采集血样,应用高效液相色谱质谱联用技术测定全血中瑞芬太尼浓度。采用执行误差(performance error,PE)的中位数(median performance error,MDPE)、PE绝对值的中位数(median absolute performance error,MDAPE)和摆动度(wobble)评价瑞芬太尼靶控输注系统的性能。结果瑞芬太尼靶控输注系统的MDPE、MDAPE和wobble分别为8.78%,16.11%和14.55%。实测浓度与目标浓度呈正相关(r=0.891,P=0.000),线性方程为Y∧=1.1046X+0.1837。结论瑞芬太尼靶控输注系统(Minto药代动力学参数)在临床应用浓度范围内能满足临床麻醉的要求。

Objective To evaluate the performance of the remifentanil target-controlled infusion（TCI） system（ Minto model） during laparoscopic surgery under inhalation and intravenous anesthesia. Methods A total of 15 patients scheduled for laparoscopic surgery received remifenanil by TCI, and the anesthesia was maintained with inhalation of isoflurane and intermittent intravenous vecuronium. The target remifentanil plasma concentration（Cp） was increased step by step, with the concentration changed at intervals of 30 minutes. The beginning Cp was 3 ng/ml, then increased to 6 ng/ml, 9 ng/ml. Blood samples were taken from radial arterial before anesthesia induction and 30 minutes after adjustment of Cp to determine the concentration of remifentanil using high performance liquid chromatography-tandem mass spectrometry （HPLC/MS/MS）. The performance of the TCI system was evaluated by median performance error（MDPE） , median absolute performance error（MDAPE） and wobble. Results The MDPE, MDAPE and wobble of the remifentanil TCI system were 8.78% , 16.11% and 14.55% , respectively. The measured concentrations of remifentanil were ^ positively correlated with Cp （ r = 0. 891, P = 0. 000 ）. The linear equation was Y = 1. 1046X ＋ 0. 1837. Conclusions The remifentanil TCI system with Minto pharmacokinetic model can meet the requirements of clinical anestehesia for Chinese patients within clinical treating concentration.