异丙酚目标控制输注系统性能的临床研究

The performance of target controlled infusion of propofol: A clinical study

目的 评价异丙酚目标控制输注 ( TCI)系统的性能。方法 自行编制内嵌药代动力学模型的控制程序。 12例择期手术病人 ,用上述程序控制佳士比 3 40 0注射泵进行异丙酚给药 ,使用Tackley发表的参数 ,HPL C荧光法检测血药浓度。结果 183个血标本的执行误差的中位数( MDPE) =- 6.8% ,执行误差绝对值的中位数 ( MDAPE) =17.9% ,分散度 =0 .3 5 % /h,摆动度 =18.3 %。诱导和切皮前后的血流动力学改变无显著性差异 ,插管后 5分血压较诱导前偏低。结论 异丙酚 TCI给药 ,系统的偏离性较小 ,精度较高且分散度小 ,但系统的摆动度偏大 。

Objective То test the performance of a target controlled infusion (TCI) system in Chinese Methods A computer program which can control a Graseby 3400 infusion pump to quickly achieve and maintain a targeted blood concentration was developed The program that imbedded a three compartment pharmacokinetic model was written in Borland Delphi 3 0 and run under Windows 95 Twelve ASA grade Ⅰ Ⅲ patients received anesthesia with propofol TCI supplemented with fentanyl The initial targeted propofol concentration was set at 4μg/ml for 10min and decreased to 3μg/ml Before incision the targeted concentration was increased to 5μg/ml for 10min and then decreased again to 3μg/ml Arterial blood propofol concentration was measured using HPLC with fluorescence detection Results The median performance error (MDPE) was 6 8% The median absolute performance error (MDAPE) was 17 9% The divergence (the percentage change of the absolute PE with time) was 0 35%/h The wobble (the median absolute deviation of each PE from the MDPE) was 18 3% The patients HR and BP were stable during induction and incision,but the BP was lower at 5min after intubation than that at the initial Conclusion The performance of the TCI of propofol is acceptable for clinical use The micro constant of the pharmacokinetic model derived from Tackley,however,is not so fit for Chinese and required to be optimized