目的:探讨靶控输注(target controlled infusion,TCI)不同血浆浓度和不同时间的瑞芬太尼对老年患者丙泊酚药代动力学的影响。方法:选取32例择期下腹部开腹手术的患者,美国麻醉医师学会(American Society of Anesthesiologists,ASA)Ⅰ～...目的:探讨靶控输注(target controlled infusion,TCI)不同血浆浓度和不同时间的瑞芬太尼对老年患者丙泊酚药代动力学的影响。方法:选取32例择期下腹部开腹手术的患者,美国麻醉医师学会(American Society of Anesthesiologists,ASA)Ⅰ～Ⅱ级,年龄65～82岁。随机分为4组,每组8例,A组复合硬膜外麻醉,B组TCI瑞芬太尼血浆浓度4μg/L,C组TCI瑞芬太尼血浆浓度7μg/L,D组TCI瑞芬太尼血浆浓度4μg/L且输注时间大于4h。所有患者均TCI丙泊酚,血浆浓度为3mg/L。术中记录脑电双频指数值(bispetral index,BIS)、心率(heart rate,HR)、桡动脉压等指标。分别于麻醉诱导前、TCI丙泊酚后1、3、5、10、15、30min及以后每30min,停止TCI丙泊酚后即刻、2、4、6、8、10、15、30、45min及1、2、4、6、8、12、24h取桡动脉血,以反相高效液相色谱-荧光法测定丙泊酚的血浆浓度。应用NONMEM软件将A组分别和B、C、D组建立全量回归模型后,将瑞芬太尼作为唯一的固定效应加入最终模型,单独考察瑞芬太尼对老年患者丙泊酚药代动力学的影响。结果:(1)4组患者术中均能维持合理的麻醉深度(BIS值40～60)和稳定的血流动力学。(2)3组(A+B组,A+C组,A+D组)丙泊酚药代动力学最终模型均符合三室开放模型,目标函数值分别为-810.1,-714.4,-896.4。将瑞芬太尼合并用药分别加入3组模型,模型的目标函数未见减小。结论:靶控输注血浆浓度4μg/L、7μg/L的瑞芬太尼以及连续输注血浆浓度4μg/L的瑞芬太尼4h以上对老年患者丙泊酚的药代动力学均没有影响。展开更多
Aim To investigate the population pharmacokinetics of propofol administered by TCI in Chinese elderly patients. Methods Thirty-two patients with ASA Ⅰ - Ⅱ , 65 - 82 years old, undergoing selective lower abdominal op...Aim To investigate the population pharmacokinetics of propofol administered by TCI in Chinese elderly patients. Methods Thirty-two patients with ASA Ⅰ - Ⅱ , 65 - 82 years old, undergoing selective lower abdominal operation were studied. Propofol was administered by target-controlled infusion with Marsh parameter. The target plasma concentration was 3 μg＇ mL^-1. Radial arterial blood samples were collected and analyzed by reversed phase HPLC with fluorescence detection. Population pharmacokinetic modeling was performed using NONMEM. Inter-individual variability and intra-individual variability of propofol were estimated for clearances and volumes of distribution. The effects of age, body weight, lean body mass, gender, height, hemoglobin, total protein, albumin, creatinine, alanine aminotrans ferase （ALT）, and aspartate aminotransferase （AST） were investigated. The effects of coadministered opioid drugs were also studied. Results The pharmacokinetics of propofol in the Chinese elderly patients was best described by a three-compartment open model. Lean body mass was found to be a covariate for system clearance at significant level （ P 〈 0.005）. The clearance decreased linearly with age as well （ P 〈 0. 005）. The apparent volume of distribution for deep peripheral compartment （V3） was influenced by gender. Elderly female patients showed a higher value for V3. Conclusion The pharmacokinetics of propofol administered by TCI in Chinese elderly patients can be well described by a three-compartment open model. Inclusion of age, lean body mass and gender as covariates significantly improved the model. To ensure the accuracy and precision of target-controlled infusion, the population pharmacokinetic model applied to the individual patient should be adjusted reasonably.展开更多
文摘目的:探讨靶控输注(target controlled infusion,TCI)不同血浆浓度和不同时间的瑞芬太尼对老年患者丙泊酚药代动力学的影响。方法:选取32例择期下腹部开腹手术的患者,美国麻醉医师学会(American Society of Anesthesiologists,ASA)Ⅰ～Ⅱ级,年龄65～82岁。随机分为4组,每组8例,A组复合硬膜外麻醉,B组TCI瑞芬太尼血浆浓度4μg/L,C组TCI瑞芬太尼血浆浓度7μg/L,D组TCI瑞芬太尼血浆浓度4μg/L且输注时间大于4h。所有患者均TCI丙泊酚,血浆浓度为3mg/L。术中记录脑电双频指数值(bispetral index,BIS)、心率(heart rate,HR)、桡动脉压等指标。分别于麻醉诱导前、TCI丙泊酚后1、3、5、10、15、30min及以后每30min,停止TCI丙泊酚后即刻、2、4、6、8、10、15、30、45min及1、2、4、6、8、12、24h取桡动脉血,以反相高效液相色谱-荧光法测定丙泊酚的血浆浓度。应用NONMEM软件将A组分别和B、C、D组建立全量回归模型后,将瑞芬太尼作为唯一的固定效应加入最终模型,单独考察瑞芬太尼对老年患者丙泊酚药代动力学的影响。结果:(1)4组患者术中均能维持合理的麻醉深度(BIS值40～60)和稳定的血流动力学。(2)3组(A+B组,A+C组,A+D组)丙泊酚药代动力学最终模型均符合三室开放模型,目标函数值分别为-810.1,-714.4,-896.4。将瑞芬太尼合并用药分别加入3组模型,模型的目标函数未见减小。结论:靶控输注血浆浓度4μg/L、7μg/L的瑞芬太尼以及连续输注血浆浓度4μg/L的瑞芬太尼4h以上对老年患者丙泊酚的药代动力学均没有影响。
文摘Aim To investigate the population pharmacokinetics of propofol administered by TCI in Chinese elderly patients. Methods Thirty-two patients with ASA Ⅰ - Ⅱ , 65 - 82 years old, undergoing selective lower abdominal operation were studied. Propofol was administered by target-controlled infusion with Marsh parameter. The target plasma concentration was 3 μg＇ mL^-1. Radial arterial blood samples were collected and analyzed by reversed phase HPLC with fluorescence detection. Population pharmacokinetic modeling was performed using NONMEM. Inter-individual variability and intra-individual variability of propofol were estimated for clearances and volumes of distribution. The effects of age, body weight, lean body mass, gender, height, hemoglobin, total protein, albumin, creatinine, alanine aminotrans ferase （ALT）, and aspartate aminotransferase （AST） were investigated. The effects of coadministered opioid drugs were also studied. Results The pharmacokinetics of propofol in the Chinese elderly patients was best described by a three-compartment open model. Lean body mass was found to be a covariate for system clearance at significant level （ P 〈 0.005）. The clearance decreased linearly with age as well （ P 〈 0. 005）. The apparent volume of distribution for deep peripheral compartment （V3） was influenced by gender. Elderly female patients showed a higher value for V3. Conclusion The pharmacokinetics of propofol administered by TCI in Chinese elderly patients can be well described by a three-compartment open model. Inclusion of age, lean body mass and gender as covariates significantly improved the model. To ensure the accuracy and precision of target-controlled infusion, the population pharmacokinetic model applied to the individual patient should be adjusted reasonably.
