心肺转流国产型和进口型氧合器对丙泊酚血药浓度的影响

The effect of domestic extracorporeal circuit on plasma concentration of propofol during cardiopulmonary bypass

目的探讨国产氧合器构成的心肺转流(CPB)回路对丙泊酚血药浓度的影响。方法 60例ASAⅡ或Ⅲ级择期在CPB下行心脏瓣膜置换术患者,随机均分为国产鼓泡组(A组)、国产膜肺组(B组)和进口膜肺组(C组)。三组在麻醉诱导插管后,实施丙泊酚靶鞚输注(TCI),用反向高效液相法测定CPB前、CPB中1、5、10、20、40、60 min及停CPB后5、10 min时的丙泊酚血药浓度。结果与CPB前比较,CPB 1 min时丙泊酚血药浓度A组下降22.6%,B组下降28.7%,但差异无统计学意义,C组明显下降31.1%(P<0.05)。B组丙泊酚浓度在CPB 20 min时恢复到CPB前水平,而A、C组在CPB 40 min时恢复到CPB前水平。三组之间丙泊酚血药浓度的差异无统计学意义。结论尽管国产氧合器与进口氧合器一样对丙泊酚有吸附作用,但国产化的CPB回路对丙泊酚血药浓度无明显影响。

Objective To investigate the effect of domestic extracorporeal circuit on plasma concentration of propofol during target controlled infusion （TCI）. Methods Sixty adult patients with mitralaortic valve diseases or double valve diseases underwent valve replacement were assigned randomly into three groups, domestic bulb oxygernator group （group A）, domestic membrane oxygernator group （group B） and Polystan membrane group （group C）. Each group has 20 cases. After intubation, all patients were performed propofol TCI and performed cardiopulmonary bypass （CPB） 1 h later. 3 ml blood sample were taken before CPB, during CPB 1, 5, 10, 20, 40, 60 min and after CPB 5, 10 rain for measuring propofol plasma concentration by reverse high performance liquid chromatography （HPLC）. Results Compared with that before CPB, propofol concentration decreased obviously at CPB 1 min and group A decreased 22.6%, group B 28.70% and group C 31.1%（P〈0.05）. 20 min later propofol concentration of group B recovered to the level before CPB value. 40 min later propofol concentration of group A or group C got the same level before CPB. There was no statistically significant difference among three groups. Conclusion The concentration of propofol in domestic extracorporeal circuit was unchanged during CPB although domestic extracorporeal circuit had sequestered as high as Polystan circuit.