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| 不同烧伤程度患者靶控输注丙泊酚的药代动力学 |
| Pharmacokinetics and pharmacodynamics of target controlled infusion of propofol in patients with different degrees of burn |
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| DOI：10.12089/jca.2018.08.011 |
| 中文关键词: 烧伤 丙泊酚 靶控输注 药代动力学 药效动力学 |
| 英文关键词: Burn Propofol Target controlled infusion Pharmacokinetic Pharmacodynamics |
| 基金项目:云南省应用基础研究(昆医联合专项)(2014FZ027) |
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| 中文摘要: |
目的 结合脑电双频指数(BIS)研究不同烧伤程度患者高代谢期靶控输注丙泊酚的药代动力学特征。
方法 选择烧伤手术患者58例,男45例，女13例，年龄18～60岁,ASA Ⅱ或Ⅲ级,按照烧伤程度将患者分为三组,A组(n=20)为对照组,瘢痕患者,行瘢痕切除修复植皮术;B组(n=20)为中度烧伤患者,行切痂植皮术;C组(n=18)为重度烧伤患者,行切痂植皮术。B、C组患者无休克表现,处于高代谢期(患者均在烧伤后6～14 d施行手术,心排血量增高)。丙泊酚以3.5 μg/ml的靶浓度TCI诱导并维持,辅以瑞芬太尼、罗库溴铵维持麻醉,维持BIS值40～60。于丙泊酚TCI前,TCI后1、2、5、10、15、20、30、40、50、60、90 min,停止TCI时及停药后1、3、5、8、10、20、30 min抽取动脉血3 ml,采用高效液相色谱-荧光法(HPLC-FLD)测定丙泊酚血浆药物浓度(Cm),用DAS软件计算程序处理数据,拟合房室模型,计算药代动力学参数。
结果 三组实测丙泊酚Cm均高于靶浓度,在TCI后2 min升高达到稳态,20 min后开始逐渐下降,C组Cm明显低于A、B组(P<0.05);C组的分布容积(V1、V2、V3)、清除率(CL)、消除速率常数(K10)均明显高于A、B组(P<0.05);三组其余药代动力学参数差异均无统计学意义。
结论 重度烧伤患者应用丙泊酚TCI需要设定更高的靶浓度及输注速率。中度烧伤患者高代谢期药代动力学参数与非烧伤患者相似。 |
| 英文摘要: |
Objective To study the pharmacokinetics and pharmacodynamics of target controlled infusion (TCI) of propofol in patients with different degrees of burn using bispectral index (BIS).
Methods Fifty-eight burned patients， ASA physical status Ⅱ or Ⅲ, 45 males and 13 females, aged 18 - 60 years, undergoing eschar excision were divided into three groups. In group A (n = 20), patients with scar were treated with scar excision and repair; group B (n = 20) moderate burned patients underwent escharectomy and skin grafting; group C (n = 18) severe burned patients underwent escharectomy and skin grafting. The induction and maintenance target concentration of propofol was 3.5 μg/ml, supplemented by remifentanil and rocuroniumto maintaining the BIS at 40 - 60. Before propofol injection, and propofol injection 1, 2, 5, 10, 15, 20, 30, 40, 50, 60, 90 min and stopping TCI propofol and after stopping TCI propofol 1, 3, 5, 8, 10, 20, 30 min, arterial blood were collected. Plasma concentration (Cm) of propofol was determined with high performance liquid chromatography-fluorescence (HPLC-FLD). The pharmacokinetic was calculated by DAS software.
Results The measured Cm of the three group were higher than target concentrations. Cm achieved steady state in about 2 min, then declined after 20 min. Group C was significantly lower than that of group A and group B (P < 0.05); pharmacokinetic parameters (V1, V2, V3, CL, K10) in group C were higher than those in group A and group B (P < 0.05); there was no significant difference of other indicators among the three groups.
Conclusion Severe burn patients need to increase the dosage to achieve the same pharmacological effect, while moderate burn patients have little difference from non burn patients. |
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