注册本刊作者作者投稿查稿
专家远程审稿编辑在线审稿
编务办公专区主编办公专区
下载文档
工作动态
联系方式
发行周期:
月刊
主管单位:
上海市卫生健康委员会
主办单位:
上海市医学会
编辑出版:
《上海医学》编辑部
联系地址:
上海市北京西路1623号
邮编:
200040
电话:
021-62178606
传真:
021-62178606
邮箱:
smasmj@shsma.org.cn
ISSN:
ISSN0253-9934
CN:
CN31-1366/R
收款账号:
1001255309008900719
账户名:
上海市医学会
开户行:
工商银行上海市静安寺支行
友情链接

当前位置：首页 > 过刊浏览->2013第2期

瑞芬太尼靶控输注用于肝脏部分切除术的准确性评价
Predictive performance of target-controlled infusion of remifentenil in patients undergoing partial hepatectomy under general anesthesia combined with epidural block

浏览(3345) 下载(0)

DOI:
作者:
李敏 ，王浩 ，缪长虹，薛张纲
LI Min，WANG Hao，MIAO Changhong，XUE Zhanggang
作者单位:
复旦大学附属中山医院麻醉科
Department of Anesthesiology，Zhongshan Hospital，Fudan University
关键词:
瑞芬太尼；靶控输注；全身麻醉；肝脏切除术
remifentanil; target-controlled infusion;general anesthesia; hepatectomy
摘要:
目的 本研究旨在用Base Primea静脉麻醉输注工作站，将瑞芬太尼/丙泊酚靶控输注（TCI）静脉全麻复合硬膜外阻滞用于肝脏部分切除术，评价瑞芬太尼靶控输注系统的执行情况。方法 选择36例ASAⅠ～Ⅱ级，18～65岁，择期行肝脏部分切除术患者，根据瑞芬太尼血浆靶浓度的不同分为三组：靶浓度2ng/ml组（R1组）；靶浓度4ng/ml组（R2组）；靶浓度6ng/ml组（R3组），每组各12例。三组患者均在静脉全麻复合硬膜外阻滞下完成手术，丙泊酚的血浆靶浓度为3μg/ml，按照各自的分组给予瑞芬太尼靶控输注至手术结束。观察并记录麻醉期间心率（HR）、平均动脉压（MAP）、脑电双频指数（BIS）、听觉诱发电位指数(AAI)。抽取桡动脉血，用液质联用分析法（LC-MS/MS）测定瑞芬太尼血药浓度。采用执行误差（PE）中位数（MDPE）、执行误差绝对值中位数（MDAPE）、摆动度（wobble）评价瑞芬太尼TCI系统执行情况。结果 术中三组患者HR、MAP、BIS、AAI比较差异无统计学意义(P>0.05)。本研究实测的瑞芬太尼浓度存在低于设定值的误差和不精确性，瑞芬太尼TCI系统的PE、MDPE、MDAPE、wobble分别为-4.87%、-5.15%、21.29%、14.34%。瑞芬太尼TCI系统能维持较为稳定的血药浓度且误差在临床可接受范围内。结论 TCI时尽管瑞芬太尼的实测浓度与设定靶浓度存在误差，但误差在临床可接受范围，瑞芬太尼TCI系统能安全有效地用于静脉全麻复合硬膜外阻滞的肝脏部分切除术患者。
Objective To study the predictive performance of target-controlled infusion of remifentenil in patients underwent partial hepatectomy under general anesthesia combined with epidural block. Methods Thirty-six, ASAⅠ～Ⅱ patients aged 18～65 underwent elective partial hepatectomy in general anesthesia combined with epidural block were enrolled, and anesthesia was induced with TCIs of remifentanil and propofol.The patients were randomized to divided into 3 groups (n=12 in each) and remifentanil with target concentration 2, 4 and 6 ng/ml was infused respectively while the target plasma propofol concentration set at 3ug/ml in all patients .The patients were intubated when the patients fails to respond to verbal command and eyelash reflex lost. Tracheal intubating was facilitated with succinylcholine 1.5mg/kg. MAP, HR, ECG, SpO2, BIS, AAI were monitored before and during anesthesia. Blood samples were taken for determination of arterial remifentanil concentration by liquid chromatography-mass spectrometry detection (LC-MS/MS) .The pharmacokinetic parameters of propofol and remifentanil in TCI were set with reports of Marsh and Minto respectively. Performance of TCI devices was determined by the median performance error (MDPE), the median absolute performance error (MDAPE) and the wobble. Results There were no significant differences on the MAP, HR, BIS, AAI among three groups during anesthesia. A total of 252 blood samples analysed and the individual prediction error(PE)，Pooled MDPE, MDAPE and wobble of remifentanil TCI system are -4.87%, -5.15%, 21.29%, 14.34%. Conclusions Remifentanil can be administered by TCI with an acceptable difference between estimated and measured plasma conentrations.The predictive performance of remifentanil TCI system was acceptable for clinical purposes in patients underwent partial hepatectomy in general anesthesia combined with epidural block.

 

主管单位：上海市卫生健康委员会  主办单位：上海市医学会
©2025《上海医学》编辑部 沪ICP备09078599号
您是本站第29251372名访问者
网站管理