异丙酚效应室靶控输注与血浆靶控输注的比较

Anesthesia with propofol by target-controlled infusion targeting effect-site vs plasma

目的 观察人工流产手术使用效应室靶控输注异丙酚时的药效学变化,并与血浆靶控输注比较。方法 50例患者随机分成效应室靶控(E)和血浆靶控(B)两组,给予芬太尼1μg·kg^(-1)后分别以4μg·ml^(-1)(E组)和6μg·ml^(-1)(B组)的靶浓度输注异丙酚,观察起效时间、恢复时间、脑电频谱(BIS)值以及心率(HR)、血压(BP)、脉搏氧饱和度(SpO_2)。结果 E组起效时间及恢复时间均显著短于B组(P<0.01),而BIS值差异无显著性(P>0.05),同时E组的SpO_2显著低于B组(P<0.05)。结论 效应室靶控和血浆靶控同样适用于人工流产手术,并且起效快、恢复快,但同时应注意其呼吸抑制作用。

Objective To evaluate the difference between the pharmacodynamic profile of propofol administered by target-controlled infusion (TCI) targeting effect site and plasma . Methods Fifty ASA I-II patients aged 16-45 yr, undergoing artificial abortion were randomly divided into two groups : group E targeting effect-site (n= 25) and group B targeting plasma (n = 25). Propofol was infused during operation by TCI after a bolus of fentanyl 1 ug.kg . In group E the target effect-site concentration of propofol was set at 4ug. ml-1, whereas in group B the target plasma propofol concentration was set at 6ug.ml-1 . The following were recorded : ( I ) the onset time:from start of propofol infusion to loss of eyelash reflex (T1) , to no response to verbal command (T2 ) and to pat on the shoulder (T3 ) ; (2) the recovery time: from discontinuation of propofol infusion to eye opening (T4 ) and to stating date of birth on request (T5 ) ; (3) the calculated plasma and effect-site propofol concentration and BIS value at the five intervals; (4) duration of anesthesia; (5) the total amount of propofol consumed arid (6) HR, BP and SpO2 before, during and after anesthesia. Results Both onset time and recovery time were significantly shorter in group E than in group B, ( P < 0. 05 or 0. 01) but there was no significant difference in BIS values between the two groups. SpO2 was significantly lower in group E than that in group B at the corresponding intervals ( P < 0.05) .Conclusion Propofol anesthesia by TCI targeting either effect-site or plasma can be used for artificial abortion. Targeting effect-site provides faster onset of and recovery from anesthesia, but may induce respiratory depression.