中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2013年
7期
408-410
,共3页
张海涛%程少文%彭磊%吴国平%梁巨雄%符集伟%王光宇%陈泽俊%吕传柱
張海濤%程少文%彭磊%吳國平%樑巨雄%符集偉%王光宇%陳澤俊%呂傳柱
장해도%정소문%팽뢰%오국평%량거웅%부집위%왕광우%진택준%려전주
丙泊酚%镇静%血液透析
丙泊酚%鎮靜%血液透析
병박분%진정%혈액투석
Propofol%Sedation%Haemodiafiltration
目的 观察丙泊酚持续镇静在连续性静-静脉血液透析滤过(CVVHDF)患者中的疗效.方法 回顾性分析海南医学院附属医院急诊重症监护病房(ICU)2009年4月至2011年6月使用丙泊酚持续镇静的74例患者的临床疗效,其中并发急性肾功能不全需要进行CVVHDF者26例,其他不需进行CVVHDF的危重患者48例,对比分析两组患者丙泊酚的持续给药时间、药物总剂量、清除率及苏醒时间；同时监测26例行CVVHDF治疗者回路流人侧和流出侧的丙泊酚血药浓度.结果 与非CVVHDF组比较,CVVHDF组丙泊酚持续镇静需要更长的给药时间(h:298.37±28.73比173.44±17.27,P＜0.05)和更大的给药剂量(g:35.89±0.76比21.82±0.62,P＜0.05)；而CVVHDF组和非CVVHDF组丙泊酚持续给药后2、6、24 h的药物清除率(ml/min,2 h:13.85±1.15比14.41±1.21,6 h:5.92±0.52比6.32±0.59,24 h:4.75±0.41比5.33±0.45)及苏醒时间(min:8.89±1.46比8.47±1.37)比较差异均无统计学意义(均P＞0.05).26例CVVHDF患者给予丙泊酚持续镇静后CVVHDF回路流入侧和流出侧的丙泊酚血药浓度无明显变化.结论 与非CVVHDF患者相比,CVVHDF患者使用丙泊酚时需要更大的给药剂量和更长的持续给药时间才能维持其良好的镇静作用,但两组对丙泊酚的清除率相同,都能够维持稳定的血药浓度,不会影响患者苏醒,且无并发症发生.
目的 觀察丙泊酚持續鎮靜在連續性靜-靜脈血液透析濾過(CVVHDF)患者中的療效.方法 迴顧性分析海南醫學院附屬醫院急診重癥鑑護病房(ICU)2009年4月至2011年6月使用丙泊酚持續鎮靜的74例患者的臨床療效,其中併髮急性腎功能不全需要進行CVVHDF者26例,其他不需進行CVVHDF的危重患者48例,對比分析兩組患者丙泊酚的持續給藥時間、藥物總劑量、清除率及囌醒時間；同時鑑測26例行CVVHDF治療者迴路流人側和流齣側的丙泊酚血藥濃度.結果 與非CVVHDF組比較,CVVHDF組丙泊酚持續鎮靜需要更長的給藥時間(h:298.37±28.73比173.44±17.27,P＜0.05)和更大的給藥劑量(g:35.89±0.76比21.82±0.62,P＜0.05)；而CVVHDF組和非CVVHDF組丙泊酚持續給藥後2、6、24 h的藥物清除率(ml/min,2 h:13.85±1.15比14.41±1.21,6 h:5.92±0.52比6.32±0.59,24 h:4.75±0.41比5.33±0.45)及囌醒時間(min:8.89±1.46比8.47±1.37)比較差異均無統計學意義(均P＞0.05).26例CVVHDF患者給予丙泊酚持續鎮靜後CVVHDF迴路流入側和流齣側的丙泊酚血藥濃度無明顯變化.結論 與非CVVHDF患者相比,CVVHDF患者使用丙泊酚時需要更大的給藥劑量和更長的持續給藥時間纔能維持其良好的鎮靜作用,但兩組對丙泊酚的清除率相同,都能夠維持穩定的血藥濃度,不會影響患者囌醒,且無併髮癥髮生.
목적 관찰병박분지속진정재련속성정-정맥혈액투석려과(CVVHDF)환자중적료효.방법 회고성분석해남의학원부속의원급진중증감호병방(ICU)2009년4월지2011년6월사용병박분지속진정적74례환자적림상료효,기중병발급성신공능불전수요진행CVVHDF자26례,기타불수진행CVVHDF적위중환자48례,대비분석량조환자병박분적지속급약시간、약물총제량、청제솔급소성시간；동시감측26례행CVVHDF치료자회로류인측화류출측적병박분혈약농도.결과 여비CVVHDF조비교,CVVHDF조병박분지속진정수요경장적급약시간(h:298.37±28.73비173.44±17.27,P＜0.05)화경대적급약제량(g:35.89±0.76비21.82±0.62,P＜0.05)；이CVVHDF조화비CVVHDF조병박분지속급약후2、6、24 h적약물청제솔(ml/min,2 h:13.85±1.15비14.41±1.21,6 h:5.92±0.52비6.32±0.59,24 h:4.75±0.41비5.33±0.45)급소성시간(min:8.89±1.46비8.47±1.37)비교차이균무통계학의의(균P＞0.05).26례CVVHDF환자급여병박분지속진정후CVVHDF회로류입측화류출측적병박분혈약농도무명현변화.결론 여비CVVHDF환자상비,CVVHDF환자사용병박분시수요경대적급약제량화경장적지속급약시간재능유지기량호적진정작용,단량조대병박분적청제솔상동,도능구유지은정적혈약농도,불회영향환자소성,차무병발증발생.
Objective To study the use of propofol sedation in patients undergoing continuous venous-venous haemodiafihration (CVVHDF) and assess the curative effects.Methods A retrospective study was conducted.Data from 74 patients with continuous sedation of propofol in emergency intensive care unit (ICU) from April 2009 to June 2011 were analyzed.There were 26 cases suffering from acute renal failure in CVVHDF group and 48 critical cases in non-CVVHDF group.Propofol administration duration,dose,the clearance rate and the average recovery time in both groups were analyzed,and plasma concentrations of propofol at inflow side and outflow side of CVVHDF circuit in 26 patients with CVVHDF were determined.Results Compared with non-CVVHDF group,it took a longer administration time (hours:298.37 ± 28.73 vs.173.44 ± 17.27,P＜0.05) and higher dose (g:35.89 ± 0.76 vs.21.82 ±0.62,P＜ 0.05) in CVVHDF group.There were no statistical significances on clearance rate at 2,6,24 hours after administration (ml/min,2 hours:13.85 ± 1.15 vs.14.41 ± 1.21,6 hours:5.92 ±0.52 vs.6.32 ±0.59,24 hours:4.75 ±0.41 vs.5.33 ±.0.45) and recovery time (minutes:8.89 ± 1.46 vs.8.47 ± 1.37) between CVVHDF and non-CVVHDF groups (all P＞0.05).Plasma concentrations of propofol at inflow side and outflow side of CVVHDF circuit were not different after propofol administration in 26 CVVHDF patients.Conclusions Compared with patients in non-CVVHDF group,the patients who received propofol in CVVHDF required higher total dosage and longer delivery time to maintain a good sedation.In both two groups clearance rate of propofol,and maintenance of a stable blood concentration were the same.The use of a proper dose of propofol in CVVHDF did not affect wake up time of the patients,there were no complications.
