固定或改变目标浓度的普鲁泊福目标控制输注的性能

目的　评价国人应用固定或改变目标血药浓度的普鲁泊福 (异丙酚 )目标控制输注 (TCI)系统的性能。方法　自行编制以药代动力学模型为基础的控制程序 ,使用Marsh的普鲁泊福参数 ,通过佳士比 3 40 0注射泵控制普鲁泊福的静脉给药速度。 2 3例择期手术病人 ,分为A、B两组 ,A组给药过程中固定目标血药浓度 ;B组给药过程中改变目标浓度4次。间断采动脉血 ,HPLC荧光法测定血药浓度。结果　313个血标本的执行误差的中位数 (MDPE) =2 6 % ,执行误差绝对值的中位数 (MDAPE) =2 2 3 % ,分散度 (divergence)= - 1 5 0 %·h-1,摆动度 (wobble) =2 2 5 %。A、B两组间MDPE差异有显著性 (P <0 0 5 )。进一步分析去除血药浓度调高后 5min内的数据 ,则两组MDPE差异无显著性 (P>0 0 5 )。结论　使用Marsh的参数进行普鲁泊福TCI麻醉 ,系统的总体性能较好。给药方案与采血时点对性能分析结果产生影响

Theperformance of target-controlled infusion of propofol with constant or altered targetconcentrations

AIM To assess the performance of targetcontrolled infusion (TCI) of propofol with constant or altered target concentrations METHODS A computer program imbedded a threecompartment pharmacokinetics model, which can control a Graseby 3 400 infusion pump to quickly achieve and maintain a targeted blood concentration (Ct), was developed by one of the authors Twentythree ASA Ⅰ～Ⅲ patients who received anesthesia with propofol TCI were divided into constant Ct group and altered Ct group Arterial blood propofol concentrations were measured using HPLC with fluorescence detection RESULTS The median performance error (MDPE) was 26% The median absolute performance error (MDAPE) was 223% The divergence (the percentage change of the absolute PE with time) was -150%·h -1 The wobble (the median absolute deviation of each PE from the MDPE) was 225% MDPE for constant Ct group was significantly lower than that for altered group(P<005) However, both MDPE and MDAPE were no significant differences when excluding the blood concentrations that were obtained within 5 minutes after Ct increased CONCLUSION By using the Marsh's pharmacokinetics constant, the performance of the TCI of propofol is acceptable for clinical use The infusion profile and the scheme of sampling influence the results of performance