急性高容血液稀释后恒速输注丙泊酚血药浓度的变化

Change of propofol plasma concentration by constant infusion after acute hypervolemic hemodilution

目的观察急性高容血液稀释(AHHD)后恒速输注丙泊酚血药浓度的变化。方法择期行脊柱侧弯后路矫形内固定术患者30例,随机均分为AHHD组(H组)和对照组(C组)。H组在麻醉诱导后静脉输注20 ml/kg羟乙基淀粉130/0.4,30 min内输完。分别在AHHD后(H组)和诱导后30 min(C组)恒速输注丙泊酚6 mg.kg-1.h-1。记录丙泊酚输注后0、1、2、4、10、15、20、25、30、35、45 min采集桡动脉血3 ml测定丙泊酚血药浓度。检测两组诱导后、输注丙泊酚前和输注丙泊酚45 min后的Hb及Hct。结果 H组患者稀释后为中度血液稀释状态。H组输注丙泊酚后各时点血药浓度均明显低于C组(P<0.01)。结论 AHHD后恒速输注丙泊酚血药浓度明显降低,应结合患者具体情况适当调整丙泊酚剂量。

Objective To investigate the effect of acute hypervolemic hemodilution （AHHD） on propofol plasma concentration by constant infusion. Methods Thirty scoliosis patients, ASA Ⅰ or Ⅱ , undergoing elective scoliosis surgery, were randomly assigned into two groups： group AHHD （group H）and control group（group C）. After intubation, Ringer＇s lactate of 5 ml/kg was delivered in each patient as basic need in both groups, meanwhile AHHD was achieved by infusing hydroxyethyl starch 130/0.4 20 ml/kg in group H. Propofol was then infused at 6 mg.kg^-1 .h^-1 in both groups. Arterial blood was drawn right before AHHD, and at 0, 1,2,4,10, 15,20,25,30,35, 45 mins after the completion of AHHD for the determination of plasma concentration of propofol in group H, and so was the blood in group C at the corresponding time. Results Hb significantly decreased from initial （11. 36±0.91）g/dl to （7.91±0.49）g/dl and Hct also significantly decreased from（37±2）% to （26±2）% at the end of AHHD. Compared with group C, the plasma concentration of propofol was significantly lower in group H （P〈0.01）. The plasma concentration of propofol tended to be steady after 20 mins infusion of propofol in two groups. Conclusion AHHD decreases propofol plasma concentration at constant infusion.