舒芬太尼在不同程度烧伤患者体内的药代动力学

目的探讨舒芬太尼在不同程度烧伤患者体内的药代动力学以及评价靶控输注舒芬太尼的准确性。方法选择烧伤科择期手术患者40例,对照组（A组）为烧伤痊愈后形成瘢痕患者10例,行瘢痕切除修复植皮术,其余30例分为轻度烧伤组（B组）、中度烧伤组（C组）、重度烧伤组（D组）,每组各10例。40例患者均以靶控输注（TCI）舒芬太尼血浆浓度0.4 ng/mL,右美托咪定0.4μg/（kg·h）持续静脉泵注,复合七氟烷,BIS值维持在4060之间。分别在麻醉前（基础）、TCI开始后1 min（TCI1）、3 min（TCI3）、5 min（TCI5）、10 min(TCI10)、15 min(TCI15)、20min(TCI20)、30 min(TCI30)、40 min(TCI40)、50 min(TCI50)、60 min(TCI60)、90 min(TCI更多     

患者自控-靶控输注系统输注舒芬太尼的准确性评价

目的 通过测定舒芬太尼血药浓度的方法来评价患者自控-靶控输注(PC-TCI)系统的准确性。方法 选择拟行气管内全麻下择期腹部手术的患者15例(ASAⅠ～Ⅱ级),于手术麻醉期间应用PC-TCI系统输注舒芬太尼,采用酶联免疫方法(Elisa)检测其血浆舒芬太尼浓度;选择执行误差(PE)的中位数(MDPE)、PE绝对中位数(MDAPE)、分散度和摆动度作为评价其准确性的指标。结果 MDPE、MDAPE、分散度、摆动度的中位数(95%可信区间)分别为－9.5% (－12.1%～－7.3%)、10.5% (7.5%～12.2%)、－2.5%/h (－6.8%/h～4.9%/h)、17.5% (10.3%～25.6%) 。实测血药浓度与预测血药浓度呈线性相关(R2＝0.945 3)。结论 患者自控-靶控输注系统的偏离度较小,精密度较高,而分散度较小,能维持较稳定的血药浓度,适合于临床应用。     

瑞芬太尼和舒芬太尼的靶控输注

瑞芬太尼是一种新型μ阿片受体激动药,具有起效迅速、清除快、可控性高、持续输注半衰期短和长时间输注无蓄积的特点,特别适合靶控输注给药。舒芬太尼是目前最强的麻醉性镇痛药,具镇痛效果显著、心血管影响小、麻醉诱导迅速、恢复及时、呼吸抑制轻等特点,持续输注半衰期较短,经靶控输注(TCI)给药血流动力学更稳定。两药都可通过TCI用于全麻诱导、维持及术后镇痛。     

瑞芬太尼靶控输注系统的准确性评价

目的评价瑞芬太尼靶控输注系统的准确性。方法12例择期手术患者,利用单片机技术控制注射泵输注异丙酚和瑞芬太尼完成临床麻醉,瑞芬太尼选用一组国人复合异丙酚靶控输注静脉全麻下的临床药代动力学参数,HPLC-UV法检测血药浓度。计算瑞芬太尼样本的执行误差(PE)、执行误差的绝对值(absPE)、稳定误差(CE)、稳定误差的绝对值(absCE)、执行误差的中位数(MDPE)、执行误差绝对值的中位数(MDAPE)、稳定误差的中位数(MDCE)、稳定误差绝对值的中位数(MDCE)。结果174个血标本PE,absPE,CE,absCE分别为-8.39%, 12.73%,-1.50%,6.34%。MDPE,MDAPE,MDCE,MDACE分别为-9.50%,11.51%,-2.24%,5.75%。实测浓度与预测浓度呈线性相关(r=0.883)。结论应用本组瑞芬太尼药代学参数嵌入TCI系统与异丙酚合并用于临床麻醉,系统的精度和稳定性较好。     

舒芬太尼靶控输注全凭静脉麻醉在围手术期的应用效果

目的探讨舒芬太尼靶控输注全凭静脉麻醉在围手术期的应用效果。方法选取2015年3月至2018年12月民权县人民医院收治的120例腹腔镜手术患者,按随机数表法分为对照组和观察组,每组60例。对照组患者接受静吸复合舒芬太尼麻醉,观察组患者接受靶控输注舒芬太尼麻醉。比较两组患者麻醉诱导前与气管拔管时的心率(HR)、收缩压(SBP)、血氧饱和度(SpO_2)。比较两组患者术后自主呼吸恢复时间、拔管时间、睁眼时间和定向力恢复时间。结果观察组患者气管拔管时HR和SBP均低于对照组,差异有统计学意义(均P<0.05)。两组气管拔管时SpO_2比较,差异无统计学意义(P>0.05)。观察组气管拔管时与麻醉诱导前HR、SBP、SpO_2比较,差异无统计学意义(均P>0.05)。对照组气管拔管时HR和SBP均高于麻醉诱导前,差异有统计学意义(均P<0.05)。对照组气管拔管时与麻醉诱导前SpO_2比较,差异无统计学意义(P>0.05)。观察组自主呼吸恢复时间、拔管时间、睁眼时间和定向力恢复时间均短于对照组,差异有统计学意义(均P<0.05)。结论对腹腔镜手术患者采用舒芬太尼靶控输注全凭静脉麻醉对血流动力学影响较小,术后恢复用时短。     

靶控输注舒芬太尼麻醉诱导时血流动力学改变的研究

目的 探讨靶控输注不同剂量舒芬太尼对手术患者麻醉诱导时血流动力学的影响.方法 将60例择期上腹部手术患者随机分为S1、S2、S3组,每组20例.S1、S2、S3组分别靶控输注舒芬太尼的效应室浓度为0.2、0.4、0.6 ng/ml,分别在诱导前(T0)、插管前即刻(T1)、插管后1 min(T2)、3 min(T3)、5 min(T4),记录三组患者SBP、DBP、MAP、HR.结果 S1组T2期SBP、MAP升高明显,与S2、S3组比较有统计学意义(P<0.05);S3组T3、T4期SBP、DBP、MAP、HR均明显降低,与S1、S2组比较有统计学意义(P<0.05).结论 靶控输注效应室浓度为0.4、0.6 ng/ml的舒芬太尼能有效抑制插管时应激反应,0.4 ng/ml的舒芬太尼更利于维持血流动力学稳定.     

老年肿瘤患者靶控输注舒芬太尼和丙泊酚的临床观察

目的:评价靶控输注舒芬太尼和丙泊酚对老年肿瘤患者麻醉的临床效果.方法:胃癌及直肠癌根治术38例,ASA Ⅰ～Ⅱ级,分两组:Ⅰ组年龄≥65岁,麻醉诱导血浆靶控输注舒芬太尼1.5 ng/ml和丙泊酚2 μg/ml,麻醉维持丙泊酚2 μg/ml,舒芬太尼0.25～0.5 ng/ml;Ⅱ组年龄25～55岁,麻醉诱导血浆靶控输注舒芬太尼1.5 ng/ml和丙泊酚3 μg/ml,麻醉维持丙泊酚3 μg/ml,舒芬太尼0.25～0.5 ng/ml.记录基础值(T1)、插管时(T2)、插管后1 min(T3)、探查时(T4)和拔管时(T5)5个时点的MAP和HR,统计舒芬太尼及丙泊酚的用量,观察停止泵入舒芬太尼至患者睁眼的时间.结果:T2两组的MAP比T1无显著差异(P＞0.05),而HR有显著差异(P＜0.05);T3两组的MAP和HR比T1有显著差异(P＜0.05);T4和T5的血流动力学比较平稳,手术过程HR有所下降(P＜0.05),但整个手术过程都比较稳定,睁眼的时间和舒芬太尼的用量两组无显著差异(P＞0.05),丙泊酚的用量两组有显著差异(P＜0.05).结论:靶控输注舒芬太尼和丙泊酚对老年肿瘤患者的麻醉是安全而可行的.     

靶控输注舒芬太尼或瑞芬太尼用于妇科腹腔镜手术麻醉的临床研究

目的:比较靶控输注（Target controlled infusion,TCI）舒芬太尼和瑞芬太尼用于妇科腹腔镜手术麻醉的临床效果。方法：92例美国麻醉医师协会（American society of anesthesiology,ASA）Ⅰ～Ⅱ级择期妇科腹腔镜手术患者,随机分为舒芬太尼组（S组）和瑞芬太尼组（R组）,每组46例。舒芬太尼组麻醉诱导效应室TCI舒芬太尼0.5 ng/ml和血浆TCI丙泊酚3 μg/ml,麻醉维持舒芬太尼0.3 ng/ml,丙泊酚3 μg/ml输注;瑞芬太尼组麻醉诱导血浆TCI瑞芬太尼4 ng/ml和血浆TCI丙泊酚3 μg/ml,麻醉维持瑞芬太尼3 ng/ml,丙泊酚3 μg/ml输注。记录2组麻醉前（T0）、诱导后3 min（T1）、插管时（T2）、切皮（T3） 、腹腔镜探查时（T4）、拔管（T5）时的收缩压、舒张压和心率的变化,比较术后患者的恢复情况,统计2组丙泊酚的用量。结果：2组T1时心率比T0均显著降低（P＜0.05）,瑞芬太尼组T1时的收缩压、舒张压低于舒芬太尼组（P＜0.05）;2组在T2、T3、T4时的收缩压、舒张压和心率差异无统计学意义（P＞0.05）;瑞芬太尼组T5时的收缩压、舒张压和心率高于舒芬太尼组（P＜0.05）;瑞芬太尼组停药至拔管的时间少于舒芬太尼组（P＜0.05）;2组丙泊酚的用量差异无统计学意义（P＞0.05）。结论：TCI舒芬太尼或瑞芬太尼用于妇科腹腔镜手术麻醉的围术期血流动力学平稳,但术毕TCI瑞芬太尼的患者应提前给予镇痛药。     

Two-stage analysis of pharmacokinetics of sufentanil administered by target-controlled infusion in Chinese patients

Background Sufentanil is a suitable choice for target-controlled infusion （TCI） because of its shorter context-sensitive half-time. The current study was to estimate the pharmacokinetics of sufentanil TCI in Chinese patients using the two-stage analysis. Methods Twelve adult patients with American Society of Anesthesiologists （ASA） physical status I or II undergoing elective surgery under general anesthesia were included. Anesthesia was induced with propofol, rocuronium and sufentanil administered by TCI lasting for 30 minutes, with target effect-site concentration of sufentanil 4 or 6 ng/ml. Frequent arterial blood samples （1.5 ml） were taken during and up to 24 hours after sufentanil TCI. Before the end of surgery, another arterial blood sample （1.0 ml） was drawn for the blood-gas analysis. Plasma sufentanil concentrations were determined by liquid chromatography-tandem mass spectrometry （limit of quantitation was 5 pg/ml）. The data were analyzed with the two-stage approach, linear regression and correlation analysis. Results The pharmacokinetics of sufentanil TCI were adequately described by a three-compartment model. The variables were derived as follows： the volume of central compartment （V1） was 5.4 L, volume of distribution at steady-state （Vdss） was 222.6 L, metabolic clearance （CI1） was 0.84 L/min and elimination half-life （t~/2y） was 389 minutes. Patients＇ age, gender and PaCO2 correlated significantly with the pharmacokinetic parameters. The Vdss, volume of slowly equilibrating compartment （V3） and t1/2 y increased, and rapid distribution clearance （012） decreased with increasing patient age. Male patients had larger values of Vdss, volume of rapidly equilibrating compartment （V2） and V3 than female patients. The Vdss and V3 increased with higher PaCO2 values. There were no significant correlations between the pharmacokinetic variables and body weight, height, lean body mass, plasma albumin, sufentanil dose, duration of surgery, pH or base excess of blood （BE-B）. Conclusions The pharmacokinetics of sufentanil TCI in Chinese patients can be optimally described by a three-compartment model. The pharmacokinetic analysis technique may affect the pharmacokinetic parameters and correlations.     

Clinical evaluation of target controlled infusion system for sufentanil administration

Background Sufentanil target controlled infusion （TCI） provides stable analgesia, better hemodynamic control than a bolus injection of intravenous anesthetics, anticipated recovery and improved quality of anesthesia during perioperative period. This study evaluated the accuracy and feasibility of TCI system for sufentanil at high concentrations in Chinese surgical patients. Methods Twelve low risk adult patients undergoing elective surgery under general anesthesia were included in this study. Sufentanil was administered with a specific TCI system incorporating the population pharmacokinetic data of sufentanil previously reported, using a target effect-site concentration of sufentanil 4 or 6 ng/ml. Sufentanil TCI duration was 30 minutes. Frequent arterial blood samples were taken during and up to 24 hours after sufentanil TCI for determination of plasma sufentanil concentrations by liquid chromatography-mass spectrometry/mass spectrometry. The changes of circulatory system function during the procedure, recovery profile and adverse effects were recorded. Measured plasma sufentanil concentrations were compared with the values predicted by the TCI system. The bias （median performance error, MDPE）, precision （median absolute performance error, MDAPE） and wobble （variability of performance error） of the sufentanil TCI system were determined. Results All patients had stable cardiovascular variables during induction and maintenance of anesthesia. Time to eye opening and extubation were （5.6±1.7） minutes when TCI set to 4 ng/ml and （7.2±2.3） minutes when set to 6 ng/ml. There was no episode of agitation, muscle rigidity or intraoperative awareness. The bias （MDPE）, precision （MDAPE） and wobble of the sufentanil TCI system were -3.7%, 18.9% and 19.6% respectively during TCI, and the MDPE, MDAPE and wobble were -29.1%, 31.7% and 15.0% respectively after TCI （up to 8 hours）. Conclusions The TCI system programmed for sufentanil at 4 or 6 ng/ml was considered acceptable for clinical use in low risk Chinese surgical patients. But the relatively larger MDPE and MDAPE after TCI suggest improvements of the Dharmacokinetic model are needed.     

Diprifusor靶控丙泊酚输注系统用于全凭静脉麻醉的临床研究

目的 研究Diprifusor靶控输注(TCI)系统用于全凭静脉麻醉(TIVA)的可行性及诱导、维持和苏醒期丙泊酚靶浓度(C1)的半效浓度(ED50)。方法 102例ASA Ⅰ-Ⅱ级、行全麻择期手术的患者,分为三个年龄组(n=34):A组19-45岁、B组46-64岁、C组65-88岁。术中以Diprifusor TCI系统推注丙泊酚,芬太尼、维库溴铵单次静推行TIVA。根据手术需要及患者生命体征调节Ct。每组随机抽取15例于麻醉的九个时点采用高效液相色谱法测定丙泊酚血药浓度(Cm)。结果 该TCI系统运作中位误差(MDPE)=-9.43％,绝对运作中位误差(MDAPE)=25.29％。诱导期A、B、C三组患者的丙泊酚CtED50别为3.48、2.82和2.50 μg/mL;维持期为2.39、1.96和2.01 μg/mL;苏醒期为1.02、0.90和0.79 μg/mL。除维持期B组与C组比较无显著差异外,其它各项C1ED50都随年龄增加而降低,且都有非常显著差异(P<0.01)。结论 Diprifusor TCI系统用于TIVA的可控性和准确性较好,较之诱导期和苏醒期,维持期Ct更准确。随着年龄的增加,患者对丙泊酚的敏感性增加,所需丙泊酚Ct降低,老年患者循环系统不良反应增多。     

丙泊酚靶控输注在妇科门诊宫腔镜手术中的应用

目的探讨丙泊酚靶控输注在妇科门诊宫腔镜手术中的麻醉效果。方法选取我院收治的行门诊宫腔镜手术的患者130例并分为观察组和对照组,观察组患者65例采用丙泊酚靶控输注进行麻醉,对照组患者65例采用丙泊酚静脉注射的方式进行麻醉。结果在意识恢复时两组患者MAP、HR均显著低于麻醉前,且观察组患者的MAP和HR均高于对照组,差异有统计学意义（P〈0．05）;在T1～T2时刻,两组患者SpO2均无显著变化,差异无统计学意义（P〉0．05）;观察组患者的诱导时间稍长于对照组,但差异无统计学意义（P〉0．05）,而苏醒时间和丙泊酚用量均低于对照组,差异有统计学意义（p〈0．05）;观察组患者术中和术后的镇痛效果满意率均高于对照组,且观察组舌后坠,术后头晕及术后需吸氧的发生率显著低于对照组,差异有统计学意义（P〈0．05）。结论丙泊酚靶控输注在妇科门诊宫腔镜手术中麻醉效果好。     

舒芬太尼复合异丙酚靶控输注对单肺通气肺内分流的影响

目的:研究舒芬太尼-异丙酚靶控静脉麻醉与异氟醚麻醉对单肺通气(One-lung ventilation,OLV)肺内分流和肺顺应性(Dynamic compliance of lung,Cdyn)的影响。方法:择期行中、下段食管癌根治手术患者20例,ASAⅠ～Ⅱ级,随机分为2组(n=10):舒芬太尼-异丙酚组(SUF组),靶控输入效应室浓度为0.5 ng/ml舒芬太尼和3μg/ml异丙酚麻醉;异氟醚组(ISO组),吸入1%～3%异氟醚维持麻醉。分别于麻醉后双肺通气30 min(T0)、单肺通气30 min(T1)、60 min(T2)、90 min(T3)等4个时间点经桡动脉、颈内静脉采血做血气分析,计算肺内分流率(Qs/Qt)和Cdyn。结果:与T0时点相比,2组Qs/Qt在T1～T3时点显著增加(P<0.05),Cdyn在T1～T3时点显著降低(P<0.05);与ISO组相比,SUF组Qs/Qt在T1～T3时点降低(P<0.05),Cdyn在T1～T3时显著增加(P<0.05)。与T0时点相比,PaO2在OLV后明显下降(P<0.05),组间相比,差异无统计学意义(P>0.05)。结论:舒芬太尼-异丙酚靶...     

肝功能衰竭患者靶控输注丙泊酚的药代动力学

目的探讨肝功能衰竭患者靶控输注（target-controlled infusion,TCI）丙泊酚的药代动力学。方法9例ASAⅣ级肝功能衰竭拟行肝移植手术患者（LF组）,另以9例ASAⅠ～Ⅱ级上腹部手术患者为对照（C组）,两组均采用TCI方式输注丙泊酚,丙泊酚靶浓度为2．5μg／ml。间断采集动脉血至用药后90min止,用气相色谱-质谱（GC—MS）法检测血浆丙泊酚浓度,经计算机软件拟合,得到各项药代动力学参数。结果与对照组相比,肝功能衰竭组的中央室分布容积、外周室分布容积及清除率均升高（P〈0．05）;两组间分布半衰期和消除半衰期比较无显著性差异（P〉0．05）。结论肝功能衰竭患者丙泊酚分布容积增大,清除率升高,在相同药物剂量时,可能不会出现药物蓄积和作用时间延长。     

Concentrations of propofol in cerebral spinal fluid: target-controlled infusion

Background Although the performance of target-controlled infusion (TCI) have been studied extensively, the accuracy and safety of a TCI system that targets the effect site remains to be demonstrated. This study was to investigate the relations of TCI of propofol to its concentrations in cerebral spinal fluid (CSF), the effect-site concentrations and bispectral index (BIS).Methods Twelve mongrel dogs were used for investigations. The target effect-site concentration was set at 3 μg/ml and the infusion was lasted for 15 minutes. CSF and blood samples were then collected and propofol concentrations were determined by using high performance liquid chromatography with fluorescence detection. BIS and hemodynamic data were monitored continuously.Results The predicted plasma concentrations were generally overestimated. Median performance error (MDPE) and absolute median performance error (MDAPE) were -10.0% and 29. 9% respectively. Propofol CSF concentrations were much lower than its effect-site concentrations.Changes in BIS were consistent with propofol concentrations in CSF, both of which changed direction at 5 minutes while the effect-site concentrations relatively lagged behind. Better correlation (r^2 =0. 9195) was found between BIS and CSF concentrations, when compared with that between BIS and effect-site concentrations ( r^2 =0. 554).Conclusion With 1% enflurane inhaled, the inconsistency of drug effect to the effect-site concentrations may result from inaccuracy of pharmacokinetic parameters. CSF may show effect-site concentrations more accurately than plasma when using target effect-site concentration infusion.     

靶控输注依托咪酯意识消失的半数有效量的测定

目的 依托咪酯是一种非巴比妥类的静脉麻醉药,半衰期短.依托咪酯具有起效快、作用时间短、体内代谢迅速、恢复平稳、对心血管系统和呼吸系统抑制轻微、有脑保护的作用等特点,在临床上被麻醉医师广泛的应用.测定靶控输注依托咪酯镇静的半数有效量以及95％有效量.了解EC50(半数有效浓度)及EC95(95％有效浓度)剂量可以帮助确定依托咪酯的安全范围与有效范围;增加依托咪酯应用的安全性;提高麻醉质量与患者的舒适程度;提高合理用药.方法 选择煤炭总医院2013年1-5月择期椎管内麻醉下行下腹部或下肢手术患者41例.ASA Ⅰ ～Ⅱ级;采用靶控输注依托咪酯镇静.将其随机分为4组,靶控浓度分别为0.2 μg/ml、0.3 μg/ml、0.4 μg/ml、0.5 μg/ml观察30 min.每隔5 min记录患者警觉/镇静评分法(OAA/S)、血压、心率、呼吸次数、血气等监测指标.改良OAA/S评分为3分以上患者视为入睡.所有患者均不给术前药,同时记录药后患者镇静程度改变情况;计算靶控输注依托咪酯使患者意识消失的EC50及EC95.结果 TCI靶控输注依托咪酯的半数有效浓度为0.333 μg/ml,95％可信限为0.284～0.374 μg/ml;依托咪酯EC95为0.468μg/ml; 95％可信限为0.412～0.491 μg/ml.结论 依托咪酯靶控输注具有血流动力学稳定、对呼吸影响小,同时具有较低的肌阵挛发生率,可以广泛的应用于临床镇静和麻醉.临床推荐剂量为0.333～0.468 μg/ml.