丙泊酚靶控输注用于儿童鼾症鼻内镜手术

目的评价丙泊酚靶控输注在儿童鼻内镜手术中对血压、心率、术野出血及术后苏醒过程的影响。方法86例因腺样体肥大拟行手术患儿,ASA为Ⅰ-Ⅱ级,随机分成二组,每组43例,B组行丙泊酚靶控输注麻醉,I组行异氟醚吸入麻醉。分别观察手术开始后10,25,45 m in血压、心率变化及术野质量评分,记录术毕患儿自主呼吸恢复时间、睁眼时间、拔管时间,观察术后恶心、呕吐、躁动的发生率。结果①两组收缩压、舒张压和术野质量评分无显著差异;②B组患儿术后自主呼吸恢复时间、睁眼时间、拔管时间显著短于I组;③I组并发症高于B组。结论丙泊酚靶控输注用于儿童鼻内镜手术,血压、心率、术野质量评分佳,术毕麻醉恢复更为迅速、优良。     

异丙酚复合瑞芬太尼TCI麻醉诱导对压力感受反射敏感性的影响

目的 观察异丙酚复合瑞芬太尼麻醉诱导对压力感受反射敏感性(barorefiex sensitivity BRS)的影响,为雏持循环系统的稳态调节提供依据.方法 30例择期行下肢骨科手术的女性患者,年龄20～40岁之间,ASA Ⅰ或Ⅱ级.按麻醉诱导药物不同随机分成两组(n=15):D组(异丙酚TCl)、DR组(异丙酚复合瑞芬太尼TCl).分别于诱导前(T0)、依托咪酯脂肪乳荆静脉注射后3 min(T1)、异丙酚达到血浆靶浓度平衡(T2)、瑞芬太尼达到血浆靶浓度平衡(T3)、气管插管后即刻(T4)用药物升压法测定BRS.结果 DR组较D组T3、T4点BRS值降低(P＜0.05).与T0、T1比较,两组患者其余时点BRS值降低(P＜0.05);与T2比较,D组T4点BRS值增高(P＜0.05),DR组T3、T4点BRS值降低(P＜0.05);与T3比较,两组T4点BRS值增高(P＜0.05).结论 异丙酚对BRS有抑制作用,复合瑞芬太尼应用会增加对BRS的抑制作用,气管插管应激反应能部分对抗二者对BRS的押制效应.     

丙泊酚靶控输注和持续泵注对颅脑手术患者颅内压的影响

目的:比较丙泊酚靶控输注和持续泵注对颅脑手术患者颅内压(ICP)的影响。方法:选取择期行颅脑手术患者60例,随机分为2组,每组30例:T组(丙泊酚靶控输注组),麻醉诱导采用丙泊酚4μg·mL-1靶控输注,给予芬太尼3～5μg·kg-1、咪达唑仑0.05mg·kg-1、罗库溴铵0.9mg·kg-1,丙泊酚维持用量为2～3μg·mL-1靶控输注;C组(丙泊酚持续泵注组),丙泊酚诱导剂量为2mg·kg-1,丙泊酚维持量为4～6mg·kg-1·h-1,余同T组。记录2组不同时点的腰部脑脊液压力(CSFP)以及手术结束时丙泊酚使用量。结果:2组患者麻醉诱导前(基础值)CSFP比较无统计学差异(P>0.05);切开硬膜前、切开硬膜后2组患者CSFP均较基础值低,且T组较C组降低更加明显,差异有统计学意义(P<0.05);在关硬膜后和手术结束时2组患者CSFP无统计学差异(P>0.05);T组丙泊酚使用量较C组明显降低(P<0.05)。结论:丙泊酚的靶控输注静脉麻醉在降低颅内压方面的作用优于丙泊酚的持续泵注。     

靶控输注与微泵输注丙泊酚用于小肠镜检查的比较研究

目的观察靶控输注与微泵输注丙泊酚用于双气囊小肠镜检查的效果和安全性。方法 40例ASAⅠ^Ⅱ级拟行双气囊小肠镜检查的患者,年龄22Ⅱ级拟行双气囊小肠镜检查的患者,年龄22⁶0岁,体质量4560岁,体质量45⁷0 kg,随机分为靶控组(TCI泵)和微泵组(恒速微泵),每组20例。分别采用靶控输注和微泵输注两种方式输注丙泊酚。靶控组以血浆药物浓度为靶目标进行靶控输注丙泊酚,靶浓度为2.570 kg,随机分为靶控组(TCI泵)和微泵组(恒速微泵),每组20例。分别采用靶控输注和微泵输注两种方式输注丙泊酚。靶控组以血浆药物浓度为靶目标进行靶控输注丙泊酚,靶浓度为2.5⁴μg/mL。微泵组以丙泊酚44μg/mL。微泵组以丙泊酚4⁸ mg/(kg?h)恒速输注。两组术中均视体动、呛咳反应调整输出血浆靶浓度。记录患者给药前(T0)、给药后1 min(T1)、给药后5 min(T2)术中1 h(T3)和苏醒时(T4)的HR、MAP、RR、SpO2的变化;观察诱导时间、苏醒时间、镜检时间、丙泊酚总用量、不良反应发生率及满意度。结果所有患者均能完成操作,微泵组给药后1 min(T1)MAP、HR、RR较给药前(T0)下降(P<0.05),靶控组MAP、HR、RR下降轻,两组比较有统计学意义(P<0.05)。给药后5 min(T2)术中1 h(T3)和苏醒时(T4)两组的HR、MAP、RR比较无统计学意义(P>0.05)。两组SpO2、诱导、苏醒时间、镜检时间及满意度无统计学意义(P>0.05)。靶控组丙泊酚总用量及不良反应发生率少于微泵组(P<0.05)。结论靶控输注丙泊酚麻醉诱导平稳,术中麻醉效果好,可减少丙泊酚的用量和不良反应。     

全麻加硬膜外阻滞行腹部手术应用异丙酚和安氟醚的比较

在全麻加硬膜外麻醉中,比较了异丙酚与安氟醚苏醒时血流动力学变化、苏醒时间和质量,20例择期腹部手术的成年病人,(ASA Ⅰ～Ⅱ级),随机分为异丙酚组(P组,n=10),安氟醚组(E组,n=10),结果表明:麻醉恢复时,两组病人循环指标均较平稳;清醒时间,P组明显短于E组,而且苏醒后再入睡情况少;术后24小时恶心、呕吐发生率也低。     

Retrospective Review of Critically Ill Patients Experiencing Alcohol Withdrawal: Dexmedetomidine Versus Propofol and/or Lorazepam Continuous Infusions

Background:

Alcohol withdrawal symptoms can be difficult to manage and may lead to an intensive care unit (ICU) admission. Patients experiencing severe alcohol withdrawal often require high doses of sedatives, which can lead to respiratory depression and the need for endotracheal intubation. Dexmedetomidine, an alpha-2 adrenoreceptor agonist, provides adequate sedation with little effect on respiratory function when compared to other sedatives.

Objective:

To evaluate sedation with a continuous infusion of dexmedetomidine versus propofol and/or lorazepam in critically ill patients experiencing alcohol withdrawal.

Methods:

A retrospective chart review was conducted on ICU admissions between March 2002 and April 2009 for alcohol withdrawal patients who necessitated treatment with a continuous infusion of dexmedetomidine, propofol, and/or lorazepam. Primary outcomes included the incidence of mechanical ventilation, length of mechanical ventilation (if applicable), and ICU and hospital length of stay.

Results:

Fifteen patients were treated with a continuous infusion of dexmedetomidine, and 17 were treated with an infusion of propofol and/or lorazepam. Two patients (13.3%) required intubation and mechanical ventilation in the dexmedetomidine group versus 10 (58.8%) in the propofol and/or lorazepam group (P = .006). Length of stay in the ICU was 53 hours for patients treated with dexmedetomidine versus 114.9 hours in the propofol and/or lorazepam group (P = .016). Hospital length of stay was less for the dexmedetomidine group, 135.8 hours versus 241.1 hours in the propofol and/or lorazepam group (P = .008).

Conclusions:

Dexmedetomidine use was associated with a decrease in the incidence of endotracheal intubation when used to sedate patients experiencing alcohol withdrawal. Patients transferred to a lower level of care faster and were discharged from the hospital sooner when treated with dexmedetomidine.Key Words: alcohol, dexmedetomidine, lorazepam, propofol, withdrawalThere are approximately 18.3 million people in the United States dependent on or abusing alcohol and 2.9 million people requiring treatment for problems related to alcohol use.¹ The impact of alcohol withdrawal syndrome can be devastating, both physically and neurologically. The syndrome can include headache, anxiety, hallucinations, nausea and vomiting, sweating, seizures, irritability, and the most severe form of alcohol withdrawal, delirium tremens. Patients experiencing delirium tremens have a mortality rate of up to 5%.² The American Society of Addiction Medicine guidelines for the management of alcohol withdrawal delirium recommend sedative-hypnotic drugs, such as benzodiazepines, as the primary agents for managing alcohol withdrawal syndrome.³The goal of alcohol withdrawal treatment is to relieve the patients’ agitation and prevent the further development of more severe symptoms. Some patients may experience symptoms such as increased levels of anxiety, hallucinations, and delirium tremens. In these severe cases, escalating benzodiazepine doses (to include initiation of a continuous infusion) or initiation of another sedative, such as propofol or phenobarbital, becomes necessary to control agitation. The use of sedatives can cause a decrease in respiratory drive, which can lead to patients requiring transfer to a higher level of care with the potential for intubation and mechanical ventilator support.At North Colorado Medical Center (NCMC), patients undergoing alcohol withdrawal are initially treated with benzodiazepines. If escalating doses of benzodiazepines are unable to control agitation and other alcohol withdrawal symptoms, patients are evaluated by the physician for transfer to the intensive care unit (ICU). In the past, the standard of care in the NCMC ICU for patients experiencing severe alcohol withdrawal not controlled by intermittent benzodiazepines was the initiation of a benzodiazepine and/or propofol infusion based on the physician’s assessment and preference. Often these patients required intubation and mechanical ventilation. Recently, however, the sedation of patients experiencing severe alcohol withdrawal is increasingly being managed with dexmedetomidine in the ICU at NCMC.Clonidine has historically been used for treatment and prophylaxis of the symptoms of alcohol withdrawal.^3–9 Dexmedetomidine is a centrally acting, relatively selective, alpha2-adrenergic agonist similar to clonidine with sedative and analgesic properties. Dexmedetomidine reduces the stress response, decreases norepinephrine and epinephrine levels, and attenuates increases in heart rate and blood pressure without depressing the respiratory drive.^10,11The use of dexmedetomidine has been noted in multiple case reports, case series, and one small randomized controlled trial as a possibly effective agent for the management of alcohol withdrawal.^12–19 The case reports and case series primarily reported on safety, reduced benzodiazepine doses, and reduced delirium scores in the use of dexmedetomidine in alcohol withdrawal patients. The one randomized, blinded, placebo-controlled trial published to date by Mueller et al compared dexmedetomidine to placebo in patients with severe alcohol withdrawal. The primary endpoint was benzodiazepine requirements in the first 24 hours and cumulative dose over the first 7 days of hospitalization. They reported a reduced 24-hour benzodiazepine dose in the dexmedetomidine group and no difference in the 7-day cumulative dose between groups.¹²One of the main advantages of dexmedetomidine is that it does not cause respiratory depression.¹¹ This is especially important in patients admitted to the ICU for severe alcohol withdrawal. Studies have demonstrated that patients admitted to the ICU with severe alcohol withdrawal have a high rate of intubation, reportedly 22% to 65%.²⁰ Ventilator-associated pneumonia (VAP) can occur in 10% to 20% of patients receiving greater than 48 hours of mechanical ventilation. Patients who contract VAP have increased hospital costs of more than $10,000 per day, increased ICU length of stay by 5 to 7 days, and, in some reports, increased mortality.²¹ Furthermore, intubation and mechanical ventilation on ICU day 1 has been recognized as a predictor of a longer length of hospital stay.²²Assessment and documentation of the effectiveness of dexmedetomidine for treatment of alcohol withdrawal, while growing rapidly, is still lacking in the medical literature. The purpose of this retrospective observational study was to evaluate the incidence and duration of mechanical ventilation and the length of ICU and hospital stay in alcohol withdrawal patients treated with dexmedetomidine, propofol, and/or lorazepam continuous infusions.     

Pharmacokinetic-Based Minibolus Delivery as an Alternative to Continuous Infusion for Drugs That Exhibit a Biophase Lag

The presence of a biophase compartment in a pharmacokinetic model indicates that the response to an administered dose of drug is damped such that the time to peak effect occurs after the peak concentration in the bloodstream. This phenomenon, which is common to most intravenous anesthetic agents, can be exploited by a drug delivery method that administers minibolus doses of drug rather than a continuous infusion. Through analysis of the frequency response behavior of the biophase compartment, a bolus magnitude and dose frequency or interval (1/frequency) can be chosen such that the oscillation in drug effect is minimized even though the plasma concentration may be changing significantly with each supplemental dose. A pharmacokinetic and pharmacodynamic based method for calculating the bolus dose size and dosing interval is presented. The trade-off between dose interval and change in drug effect is exemplified through computer simulation of this strategy applied to delivery of the neuromuscular blocking agent pancuronium. The method provides a repetitive perturbation to the pharmacokinetic and pharmacodynamic system that can aid in model parameter identification during closed loop applications.     

丙泊酚靶控输注准确性的研究进展

靶控输注（target-controlled infusion,TCI）是一种计算机控制的药物输注技术,是根据药动学参数计算维持靶浓度的药物输注速度。丙泊酚TCI广泛用于临床麻醉,可对绝大多数患者进行较为准确的麻醉,但有些情况下TCI系统并不能精准预测实际血药浓度,进而影响医师对实际药物浓度的判断,对患者产生不良影响。结合近年文献,本文就影响丙泊酚TCI准确性的因素做一综合阐述。从药动学模型的选择、个体间药动学的差异和围术期病理生理改变3个方面阐述影响丙泊酚TCI准确性的因素,以提醒麻醉医师关注特定情况下患者丙泊酚药动学的差异,警惕因TCI给药偏差所带来的不良反应,根据相关监测指标调整丙泊酚用药浓度和用药方案。     

Evaluation of Prolonged Versus Continuous Infusions of Piperacillin/Tazobactam During Shortages of Small Volume Parenteral Solutions

Background: In 2017, a national drug shortage of small volume solutions significantly affected the preparation of intravenous antibiotics. In response, a continuous infusion administration protocol for piperacillin/tazobactam (PIP/TAZ) was implemented. Objective: To compare the outcomes of continuous to prolonged infusions of PIP/TAZ in the setting of drug shortages. Methods: This study is a single-center, retrospective cohort study in a community hospital of patients 18 years and older who received intravenous PIP/TAZ through 2 different dosing strategies of intravenous antibiotics from December 2016 to January 2018. Data were collected for 2 months on patients receiving prolonged infusions of PIP/TAZ prior to November 2017 and for 2 months on patients receiving continuous infusions of PIP/TAZ after November 2017. Results: A total of 90 patients who received PIP/TAZ via either prolonged (n = 47) or continuous infusion (n = 43) were evaluated. There were no differences between the groups in mortality (3 vs 2 deaths, P = 1.00), length of therapy (6 ± 4 vs 6 ± 3 days, P = .86), or length of stay (9 ± 7 vs 8 ± 6 days, P = .47). Additionally, no differences were noted between incidences of thrombocytopenia (P = .41), Clostridioides difficile infection (P = .48), acute renal failure (P = 1.00), seizures (P = 1.0), or 30-day readmission rates (P = .27). Conclusions: Administration of continuous infusion PIP/TAZ appears to be a viable mitigation strategy during small volume fluid shortages. Future cost-effectiveness studies may provide information on the financial impact of continuous infusions during costly drug shortages.     

手术用药闭环化管理模式的建立与持续改进

目的 加强手术用药的质量与使用管理,保证患者术中用药安全、有效、及时。方法 在手术室成立手术药房,制订工作制度、岗位职责及标准操作规程,由药剂师负责对药品进行管理;以药箱和药盒为转运载体,对术中用药实行闭环化管理,即药剂师按照目录预先补充药箱和药盒中药品,麻醉医师手术前到药房领取所需药箱和药盒或其他药品,手术结束后将剩余药品和空安瓿交还手术药房,药剂师对药品实际使用量、医嘱开具量及空安瓿数量进行核对。结果 手术药房建立后,药品质量得到了有效监控,处方质量得到了显著提升,药品实际使用量、医嘱开具量及空安瓿数量达到了一致。结论 在手术室成立手术药房并建立闭环化药品管理模式,可实现对手术用药的精细化管理。     

丙泊酚联合瑞芬太尼靶控输注对老年患者髋关节置换术后认知功能的影响

目的：探讨丙泊酚联合瑞芬太尼靶控输注对老年患者髋关节置换术后认知功能的影响。方法：将70例拟行髋关节置换术的老年患者（美国麻醉医师协分级：Ⅱ～Ⅲ级）以随机数字表法分为2组各35例。观察组患者给予丙泊酚联合瑞芬太尼靶控输注麻醉,对照组给予芬太尼联合七氟醚麻醉,观察、统计2组患者术后认知功能障碍发生率、苏醒时间、拔管时间等指标。结果：观察组患者术后自主呼吸恢复时间、苏醒时间、拔管时间均明显短于对照组,差异有统计学意义（ P＜0．05）;观察组患者术后3、6 h的简易智能精神状态检查量表评分均低于对照组,差异有统计学意义（ P＜0．05）。结论：丙泊酚联合瑞芬太尼靶控输注能缩短老年患者髋关节置换术后的清醒时间,降低认知功能障碍发生率。     

优化门诊静脉输液流程管理的效果观察

目的:研究分析优化门诊静脉输液流程管理的效果。方法:某院2014年10月~2015年10月实施优化门诊静脉输液流程管理措施,调查2013年9月~2014年9月来某院门诊输液的患者110名(对照组)和2014年10月~2015年10月实施流程管理措施同期来某院门诊输液的患者110名(观察组)对护理工作的满意度,记录护理不良事件的发生情况,分析该管理措施的应用效果。结果:观察组患者护理安全性、岗位设置合理性、等候时间以及对护理工作的满意度均优于对照组,有统计学意义(P0.05)。结论:优化门诊静脉输液流程管理的效果较好,可有效改善护理质量,提高患者对护理工作的满意度,值得推广应用。     

丙泊酚及氯胺酮持续泵注与间断静注的静脉全麻比较

目的比较丙泊酚复合氯胺酮静脉泵注与间断静注的静脉全麻效果及安全性。方法　20例ASA　I～II级静脉全麻手术患者随机为I、II组,每组10例,I组为丙泊酚及氯胺酮分次静注组,II组为丙泊酚及氯胺酮持续静脉泵注组。两组术前3分钟静注丙珀酚0.6mg/kg,氯胺酮1mg/kg。I组术中当麻醉转浅时静注丙泊酚(0.6mg/kg)和(或)氯胺酮(1mg/kg),Ⅱ组术中以微泵泵注丙泊酚(1～3mg·kg-1·h-1),氯胺酮(2～4mg·kg-1·h-1)。记录麻醉前至手术进行1小时每隔5分钟测得的平均动脉压(MAP)、呼吸(R)及脉搏氧饱和度(SpO);整个手术过程中麻醉药用量。结果2麻醉期间I组MAP、R波动大,Ⅱ组较平稳;I组有4例SpO下降至88%～94%;Ⅱ组所有病人SpO达98%～100%以上,22两组比较差异有显著性。Ⅱ组人均氯胺酮及丙泊酚用量显著多于Ⅰ组。结论　氯胺酮及丙泊酚微泵泵注给药麻醉效果好,术中BP和R平稳,麻醉药用量少,安全性好。     

顺铂胸腔灌注法治疗胸部手术后乳糜胸

目的 回顾分析12例胸部外科术后乳糜胸的保守治疗。方法 12例患者每日引流量500ml—1200ml。采用顺铂水针剂80—100mg胸腔灌注并12h夹管。结果 11例在短期内治愈。疗程3—7d，无任何并发症及后遗症。1例治疗无效及时改手术治疗痊愈。结论 顺铂水针剂胸腔灌注治疗胸部外科术后乳糜胸具有安全、有效、简单、无痛苦的特点，值得临床推广应用。     

瑞芬太尼与曲马多复合异丙酚静脉麻醉用于宫腔镜电切术

目的 探讨瑞芬太尼与曲马多复合异丙酚用于宫腔镜电切术的麻醉效果.方法 选择门诊ASA Ⅰ～Ⅱ级宫腔镜电切术患者60例,随机分为瑞芬太尼组(R组)、曲马多组(T组)和单用异丙酚组(P组),每组各20例,R组瑞芬太尼1.0 μg·kg-1持续静注60秒,异丙酚2mg?kg-1诱导,T组曲马多2mg·kg-1 异丙酚2mg·kg-1诱导,P组单用异丙酚2mg·kg-1诱导,维持每次追加异丙酚0.5～1.0mg·kg-1,观察术中血流动力学的变化,注射痛和术后宫缩痛的发生情况,记录异丙酚用量、手术时间以及不良反应.结果 三组麻醉后SBP和DBP有不同程度下降(P＜0.01),R组HR诱导后5min、7min与诱导前比较明显下降(P＜0.01),R组、T组注射痛明显低于P组(P＜0.01),T组术后宫缩痛、呼吸抑制发生率明显低于R组、P组(P＜0.0D,R组、P组组间无差异(P＞0.05).R组、T组异丙酚用量明显少于P组(P＜0.01).术后患者无恶心、呕吐发生.结论 瑞芬太尼与曲马多复合异丙酚用于宫腔镜电切术较单用异丙酚具有麻醉效果好,能减少异丙酚用量,减轻异丙酚的注射痛,值得临床推广应用.     

某院4320张门诊处方的分析

目的了解我院门诊处方书写质量及合理用药基本情况,提高临床合理用药水平。方法以《处方管理办法》《、医院处方点评管理规范》等为依据,随机抽取我院2011年7～12月门诊处方共4320张,采用Excel软件进行数据处理,对处方点评指标、不合格处方进行归类、分析。结果我院平均用药品种数1.97种,抗菌药物使用率26.76%;处方不合格率占调查总数的1.6%,其中书写不规范占调查总数的0.72%,不合理用药处方占调查总数的0.88%,表现为适应证不适宜、用法用量不适宜、联合用药不适宜等。结论虽然我院门诊处方书写质量及合理用药水平基本合理,但还需进一步提高。建议通过完善院内规章制度、充分发挥医院信息系统优势及药学技术人员的专业技能来提高门诊处方质量。     

品管圈在提高门急诊输液室备用输注药品管理中的应用

目的探讨品管圈活动在门急诊输液室备用输注药品管理中的应用效果及提高患者用药安全。方法分析开展品管圈活动前后门急诊输液室备用输注药品存在的不规范事件相关数据,查找药品管理上存在的问题,制定整改措施。结果备用输注药品不规范事件由活动前的平均18件/月减少到活动后6件/月,进步率达到66.67%,目标达成率为109.09%。结论品管圈活动规范了门急诊输液室备用输注药品的管理,减少了不规范事件次数,增强了科室护理团队意识,提升了护士药学知识水平,为患者用药安全提供了有力保障。     

Use of Target Controlled Infusion to Derive Age and Gender Covariates for Propofol Clearance

BACKGROUND AND OBJECTIVE: Attempts to describe the variability of propofol pharmacokinetics in adults and to derive population covariates have been sparse and limited mainly to experiments based on bolus doses or infusions in healthy volunteers. This study aimed to identify age and gender covariates for propofol when given as an infusion in anaesthetized patients. STUDY DESIGN AND SETTING: One hundred and thirteen patients (American Society of Anesthesiologists class I or II and aged 14-92 years) were anaesthetized for elective surgical procedures with propofol using a target controlled infusion (TCI) system and with alfentanil as a baseline analgesic infusion. Frequent venous blood samples were obtained for measurement of propofol plasma concentrations. PHARMACOKINETIC AND STATISTICAL ANALYSIS: Pharmacokinetic accuracy was determined by the percentage prediction error, bias and precision, as were wobble and divergence. The clearance of propofol from the central compartment was determined for each patient using the computerized record of the infusion profile delivered to each patient, together with relevant blood propofol concentration estimations. For each patient, the nonlinear mixed-effects modelling (NONMEM) objective function was employed to determine the goodness of fit. RESULTS: The population distribution of propofol clearance was subsequently found to have a Gaussian distribution only in the log domain (mean value equivalent to 26.1 mL/kg/min). The distribution in the normal domain was consequently asymmetric, with a slight predominance of patients with high values of clearance (5% and 95% confidence limits 17.7 and 42.1 mL/kg/min, respectively). Using regression analysis, gender and age covariates were derived that optimized the performance of the target controlled infusion system. The clearance (CL) of propofol in male patients changed little with age (CL [mL/kg/min]=26.88-0.029xAge; r2=0.006) whereas that in female patients had a higher initial value but decreased progressively with age (CL [mL/kg/min]=37.87-0.198xAge; r2=0.246). CONCLUSION: We achieved a relatively simple and practical covariate model in which the variability of pharmacokinetics within the study population could be ascribed principally to variability in clearance from the central compartment. Pharmacokinetic simulation predicted an improved performance of the TCI system when employing the derived covariates model, especially in elderly female patients.     

丙泊酚靶控输注和七氟烷吸入对顺式阿曲库铵药效学的影响

目的:比较丙泊酚靶控输注(TCI)复合瑞芬太尼全凭静脉麻醉和七氟烷复合瑞芬太尼麻醉对单次插管剂量顺式阿曲库铵肌松效应的影响.方法:ASA Ⅰ或Ⅱ级的择期全麻患者42例,随机均分为丙泊酚(P)组和七氟烷(S)组.麻醉诱导后给予0.2 mg/kg的顺式阿曲库铵后插管;P组和s组麻醉维持分别采用丙泊酚TCI-泵注瑞芬太尼和吸入1.3倍肺泡最小有效浓度(1.3 MAC)七氟烷-泵注瑞芬太尼.使用加速度肌松监测仪观察拇内收肌的收缩反应,记录顺式阿曲库铵的起效时间、无反应时间、肌松维持时间及恢复指数(RI)等指标.结果:2组之间肌松起效时间、无反应时间及单刺激肌颤搐强度(T1)25%时间差异无统计学意义(均P>0.05),S组25%四个成串刺激比(TOFr)及恢复指数较P组明显延长(P<0.05).结论:单次插管剂量的顺式阿曲库铵在丙泊酚TCI-泵注瑞芬太尼麻醉下肌松维持及恢复无明显变化,而在吸入1.3 MAC七氟烷-泵注瑞芬太尼麻醉下恢复时间明显延长,提示以七氟烷维持全麻,顺式阿曲库铵剂量应酌减,以免术后肌松残留.