靶控输注异丙酚和芬太尼全静脉麻醉

Target-controlled infusion of propofol and fentanyl in total intravenous aneshesia

目的:以效应室浓度为目标,完成异丙酚与芬太尼靶控输注全静脉麻醉。方法:对两组成年病人应用微机控制输液泵完成静脉麻醉的诱导与维持,效应室目标浓度异丙酚为4μg/ml、芬太尼为2μg/ml。异丙酚血药浓度应用荧光分光光度法,芬太尼应用放射免疫法测定。结果:第一组8例,0～120分钟显示异丙酚平均血药浓度偏高,预测误差绝对值中位数MDAPE=25%;芬太尼血药浓度低于目标值,MDAPE=35.5%。第二组9例,重新选择药代动力学参数后,平均血药浓度较上组改善,异丙酚MDAPE=15.5%,芬太尼MDAPE=37.75%。结论:以效应室浓度为目标靶控输注静脉麻醉起效快,维持稳定,不同作者报告的参数对靶控误差有影响。

Objective: To perform target-controlled infusion (TCI) in total intravenous anesthesia (TIVA) of propofol and fentanyl. Method: Using effect compartment modeling, computer controlled infusion(the computer software was developed by Coezee and Pina) was performed during induction and maintenance of anesthesia in two groups of adult patients. The target predicted concentration of theoretical effect-site compartment for propofol was 4μg/ml and for fentanyl was 2μg/ml. The plasma concentration (Cm) of propofol was determined by fluorospectrophotometry and Cm of fentanyl was measured with radioimmunoassay. Result: The mean Cm from 0 to 120 min showed that excessive dose of propofol was administered, MDAPE=25%,however the mean Cm of fentanyl was lower than the target level obviously,MDAPE=35.5% in first group. After an imitative calculation,another pharmacokinetic (PK) parameter sets of propofol and fentanyl were selected in the second group,MDAPE=15.5% for propofol and MDAPE=37. 75% for fentanyl. Conclusion: The concentrations of propofol and fentanyl in the effect site compartment can be achieved rapidly by using the effect compartment control algorithm. The PK parameter,described by different authors influences the accuracy of TCI administration.