效应室浓度作为目标浓度靶控输注异丙酚的脑摄取研究

Brain uptake of propofol during target-controlled infusion when effect compartment co-ncentration is targeted

目的研究靶控输注(target-contro11edinfusion,TCI)时效应室浓度(effect compartment concentration,ECC)与异丙酚的脑摄取之间的关系.方法ASA Ⅰ～Ⅱ级择期腹部手术病人12例,以ECC 4.00 μg/ml为目标浓度进行异丙酚TCI静脉全身麻醉,给药后不同时间点同步抽取桡动脉、颈内静脉球部全血各1 ml,以高效液相色谱荧光法测定异丙酚的血药浓度,并计算动脉-颈内静脉球部血药浓度-时间曲线下面积差(area undercurve ofartenal-jugular bulb concentrationdifference,AUCa-jv值.结果给药后,ECC达目标浓度前,各时间点ECC与AUCa-JV呈显著正相关(r ECC-AUC.977,P<001),而动脉血药浓度(arterial concentration,Ca)、颈内静脉球部血药浓度(jugular bulb venous concentration,Cibv)与AUCa-jv不相关(rca-AUc=0 054,P=0.92;rcjbv-AUc=0.335,P=0.516).TCI维持ECC为4.0μg/ml至停药前,各时间点Ca与Cjbv间经统计分析无显著差异(p=0.512).停止输注异丙酚至病人意识清醒时.各时间点ECC与AUCa-jv呈正相关(rECC-AUc=0.942,P＜0.005),Ca、Cbv也与AUCa-jv呈正相关(rca-AUc=0.986,P<0.001;rcjby-AUC=0.974,P<0.001).结论以ECC为目标浓度的异丙酚TCI时,ECC与AUCa-jv相关性显著,可同步反映异丙酚的脑摄取变化.

Objective To studythecorrelationbetweentheeffectcompartmentconcentration(ECC)andthebrainuptakeof propofolduringsedationby target-controlledinfusion(TCI).Method TwelveASA physicalstatusⅠtoⅡpatientswith neithercardiacnorintracranialdiseaseswerescheduledforelectiveabdominaloperation.Computer-assistedtarget-controlled infusionof propofolwas performedfor generalanesthesiain allpatientswiththetargetECCsetat4.0μg/ml.Theplasma propofolconcentrationsweremeasuredsimultaneouslyfromtheradialarteryandthejugularbulbat differenttimepointsby highperformanceliquidchromatography(HPLC),andtheareaundertime-concentrationcurve(AUC a-jv )was calculated.Result Beforereachingthetargetpropofolconcentrationof4.0μg/ml(4.7±0.16min),EECwas positivelycorrelatedwith AUC a-jv (r ECC-AUC =0.977,P<0.001),butneitherthearterial(C a )nor jugularbulbpropofolconcentrations(C jbv )showedsuch relationto AUC a-jv (r Ca-AUC =0.054,P=0.92;r Cjbv-AUC =0.335,P=0.516).WhenECCwas controlledat4.00μg/ml by TCI,C a was comparablewithC jbv (P=0.512).Positivecorrelationwas notedbetweenAUC a-jv andECC(r ECC-AUC =0.942,P<0.005)afterthe terminationof infusiontilltheconsciousnessrecoveryof thepatients,andC a andC jbv showedsimilarcorrelationwithAUC a-jv (r Ca-AUC =0.986,P<0.001;r Cjbv-AUC =0.974,P<0.001).Conclusion DuringTCIof propofolwithECCas thetargetconcentration,ECCissignficantlycorrelatedwithAUC a-jv to reflectthedynamicchangesincerebralpropofoluptake.