靶控输注临床常用浓度舒芬太尼的效能:前瞻性随机对照研究

Performance of Target-controlled Infusion of Sufentanil at Commonly Used Concentration:a Prospective Randomized Controlled Trial

目的探讨靶控输注(target-controlled infusion,TCI)临床常用浓度(0.2~1.0 ng/ml)舒芬太尼的效能。方法择期全麻腔镜手术30例,ASAⅠ或Ⅱ级,年龄(43.8±12.5)岁。采用随机数序列法随机分为3组(n=10):0.2 ng/ml组(Ⅰ组)、0.3 ng/ml组(Ⅱ组)和0.4 ng/ml组(Ⅲ组)。麻醉诱导和维持采用TCI舒芬太尼,复合吸入七氟烷维持麻醉。经桡动脉取血,液相色谱-质谱联用法测定舒芬太尼浓度。计算偏离度(median performance error,MDPE)、精确度(median absolute performance error,MDAPE)、摆动度和离散度。结果Ⅰ、Ⅱ、Ⅲ组MDPE分别是3.5%、8.1%和6.1%,MDAPE分别为25.4%、20.0%和25.7%,摆动度分别为23.1%、23.0%和24.5%,离散度分别为-0.309%/h、-0.007%/h和-0.586%/h。总体MDPE、MDAPE、摆动度和离散度分别为5.4%、22.5%、23.3%和-0.271%/h。结论临床常用浓度舒芬太尼TCI效能在临床可接受范围内,随时间延长TCI系统稳定性良好。舒芬太尼实测血药浓度较靶浓度高约5%,舒芬太尼浓度0.3 ng/ml更适合TCI。

Objective To investigate the performance of target-controlled infusion(TCI)of sufentanil at commonly used concentration(0.2-1.0 ng/ml)in general anesthesia.Methods Thirty patients with ASAⅠorⅡ,aged(43.8±12.5)years old and scheduled for selective surgery under general anesthesia,were included in this study.The patients were divided into 3 groups with 10 cases in each group by using the computer-generated sequence of random numbers:0.2 ng/ml group(groupⅠ),0.3 ng/ml group(groupⅡ)and 0.4 ng/ml group(groupⅢ).Anesthesia was induced and maintained with sufentanil TCI,and the patients also inhaled sevoflurane during the maintenance of anesthesia.Arterial blood samples were collected,the concentration of sufentanil was determined by liquid chromatography-mass spectrometry.The median performance error(MDPE),median absolute performance error(MDAPE),wobble,and divergence were calculated.Results In the groupⅠ,ⅡandⅢ,the MDPE of sufentanil TCI was 3.5%,8.1%and 6.1%,the MDAPE was 25.4%,20.0%and 25.7%,the wobble was 23.1%,23.0%and 24.5%,and the divergence was-0.309%/h,-0.007%/h and-0.586%/h,respectively.The pooled MDPE,MDAPE,wobble and divergence were 5.4%,22.5%,23.3%and-0.271%/h,respectively.Conclusions The performance of sufentanil TCI at commonly used concentration in general anesthesia is within the clinically acceptable range,and the system of sufentanil TCI shows good stability along with time.The measured blood concentration of sufentanil is about 5%higher than the target concentration,so that a sufentanil concentration of 0.3 ng/ml is more suitable for TCI.