中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2011年
3期
324-326
,共3页
胡利国%方才%郭凤林%黄晓晖%张善堂
鬍利國%方纔%郭鳳林%黃曉暉%張善堂
호리국%방재%곽봉림%황효휘%장선당
儿童%哌啶类%药物释放系统
兒童%哌啶類%藥物釋放繫統
인동%고정류%약물석방계통
Child%Piperidines%Drug delivery system
目的 评价小儿瑞芬太尼靶控输注(TCI)系统的准确性.方法 择期行五官科或泌尿科手术小儿30例,年龄3～12岁,体重10～40 kg,采用随机数字表法,将患儿随机分为2 ng/ml瑞芬太尼组(Ⅰ组)和4 ng/ml瑞芬太尼组(Ⅱ组),每组15例.Ⅰ组和Ⅱ组采用内嵌Minto药代动力学参数的瑞芬太尼TCI系统输注瑞芬太尼,血浆靶浓度分别为2、4 ng/ml,静脉注射异丙酚2 mg/kg,待患儿意识消失后静脉注射维库溴铵0.1 mg/kg诱导气管插管后行机械通气.两组瑞芬太尼血浆靶浓度维持不变,调节异丙酚输注速率,维持脑电双频谱指数45～65或听觉诱发电位指数＜30,间断静脉注射维库溴铵维持肌松.于TCI瑞芬太尼开始后5、10、20、30、40、50、60 min时抽取桡动脉血样,采用高效液相色谱法测定瑞芬太尼血药浓度,计算TCI系统的偏离度、精确度和摆动度.结果 与血浆靶浓度比较,两组瑞芬太尼实测浓度均升高(P＜0.05);Ⅰ组TCI系统的偏离度、精确度和摆动度分别为20.0%、30.0%和25.0%,Ⅱ组分别为17.5%、17.5%和12.5%,与Ⅰ组比较,Ⅱ组TCI系统的精确度和摆动度降低(P＜0.05),偏离度差异无统计学意义(P＞0.05).结论 3～12岁小儿采用内嵌Minto药代动力学参数的TCI系统输注瑞芬太尼时准确性不高.
目的 評價小兒瑞芬太尼靶控輸註(TCI)繫統的準確性.方法 擇期行五官科或泌尿科手術小兒30例,年齡3～12歲,體重10～40 kg,採用隨機數字錶法,將患兒隨機分為2 ng/ml瑞芬太尼組(Ⅰ組)和4 ng/ml瑞芬太尼組(Ⅱ組),每組15例.Ⅰ組和Ⅱ組採用內嵌Minto藥代動力學參數的瑞芬太尼TCI繫統輸註瑞芬太尼,血漿靶濃度分彆為2、4 ng/ml,靜脈註射異丙酚2 mg/kg,待患兒意識消失後靜脈註射維庫溴銨0.1 mg/kg誘導氣管插管後行機械通氣.兩組瑞芬太尼血漿靶濃度維持不變,調節異丙酚輸註速率,維持腦電雙頻譜指數45～65或聽覺誘髮電位指數＜30,間斷靜脈註射維庫溴銨維持肌鬆.于TCI瑞芬太尼開始後5、10、20、30、40、50、60 min時抽取橈動脈血樣,採用高效液相色譜法測定瑞芬太尼血藥濃度,計算TCI繫統的偏離度、精確度和襬動度.結果 與血漿靶濃度比較,兩組瑞芬太尼實測濃度均升高(P＜0.05);Ⅰ組TCI繫統的偏離度、精確度和襬動度分彆為20.0%、30.0%和25.0%,Ⅱ組分彆為17.5%、17.5%和12.5%,與Ⅰ組比較,Ⅱ組TCI繫統的精確度和襬動度降低(P＜0.05),偏離度差異無統計學意義(P＞0.05).結論 3～12歲小兒採用內嵌Minto藥代動力學參數的TCI繫統輸註瑞芬太尼時準確性不高.
목적 평개소인서분태니파공수주(TCI)계통적준학성.방법 택기행오관과혹비뇨과수술소인30례,년령3～12세,체중10～40 kg,채용수궤수자표법,장환인수궤분위2 ng/ml서분태니조(Ⅰ조)화4 ng/ml서분태니조(Ⅱ조),매조15례.Ⅰ조화Ⅱ조채용내감Minto약대동역학삼수적서분태니TCI계통수주서분태니,혈장파농도분별위2、4 ng/ml,정맥주사이병분2 mg/kg,대환인의식소실후정맥주사유고추안0.1 mg/kg유도기관삽관후행궤계통기.량조서분태니혈장파농도유지불변,조절이병분수주속솔,유지뇌전쌍빈보지수45～65혹은각유발전위지수＜30,간단정맥주사유고추안유지기송.우TCI서분태니개시후5、10、20、30、40、50、60 min시추취뇨동맥혈양,채용고효액상색보법측정서분태니혈약농도,계산TCI계통적편리도、정학도화파동도.결과 여혈장파농도비교,량조서분태니실측농도균승고(P＜0.05);Ⅰ조TCI계통적편리도、정학도화파동도분별위20.0%、30.0%화25.0%,Ⅱ조분별위17.5%、17.5%화12.5%,여Ⅰ조비교,Ⅱ조TCI계통적정학도화파동도강저(P＜0.05),편리도차이무통계학의의(P＞0.05).결론 3～12세소인채용내감Minto약대동역학삼수적TCI계통수주서분태니시준학성불고.
Objective To evaluate the accuracy of remifentanil target-controlled infusion (TCI) system in children.Methods Thirty ASA Ⅰ patients, aged 3-12 yr, weighing 10-40 kg, scheduled for elective ear-nosethroat or urological surgery, were randomly divided into 2 groups with 15 patients in each group:2 ng/ml remifentanil group (group Ⅰ) and 4 ng/ml remifentanil group (group Ⅱ). Anesthesia was induced with iv injection of propofol 2 mg/kg and TCI of remifentanil. Remifentanil was administered with a specific TCI system incorporating the pharmacokinetic parameters of Minto.The target plasma concentrations of remifentanil were set at 2 or 4 ng/ml. Tracheal intubation was facilitated with vecuronium 0.1 mg/kg after the children lost consciousness. The children were mechanically ventilated.Anesthesia was maintained with TCI of remifentanil, iv infusion of propofol and intermittent iv boluses of vecuronium. The target plasma concentration of remifentanil remained unchanged and bispectral index value was maintained at 45-65 or auditory evoked potentials index value ＜ 30 by adusting the infusion rate of propofol.Arterial blood samples were taken at 5, 10, 20, 30, 40, 50 and 60 min after TCI remifentanil was stared for determination of blood remifentanil concentrations by high performance liquid chromatography. Median prediction performance error (MDPE),median absolute performance error (MDAPE) and wobble of remifentanil TCI system were calculated. Results The measured concentrations of remifentanil were significantly higher than the target plasma concentrations in both groups (P＜0.05). The MDPE, MDAPE and wobble were 20.0% , 30.0% and 25.0% respectively in group Ⅰ , and 17.5%, 17.5% and 12.5% respectively in group Ⅱ . TheMDAPE and wobble were significantly decreased in group Ⅱ compared with group Ⅰ(P＜0.05).Conclusion When remifentanil is administered using a specific TCI system incorporating the pharmacokinetic parameters of Minto in children of 3-12 years old, the accuracy is not high.
