【摘要】 目的探讨梗阻性黄疸病人靶控输注(TCI)异丙酚的药代动力学。方法择期手术病人24例,ASAⅠ或Ⅱ级,按胆红素水平分成3组(n=8),对照组:血清总胆红素(sTBL)<17．1μmol／L;轻度梗阻性黄疸组(B组):17.1μmol／L≤sTBL≤171.1μmol／L;中重度梗阻性黄疸组(C组):sTBL> 171．1μmol／L。三组均以血浆靶浓度3．0μg／ml TCI异丙酚直至手术结束。分别于以下时点取桡动脉血:TCI开始后0．5、1、2、4、6、8min、麻醉维持过程中每隔15 min、停止TCI后即刻、2、4、6、8、10、20、30、40、50、60、90、120、180、240、300、360 min,用高效液相色谱荧光法测定血浆异丙酚浓度,用NONMEM软件分析药代动力学参数。结果TCI异丙酚的群体药代动力学大部分(18／24)最适合用三室模型来描述,小部分(6／24)最适合用二室模型来描述。三组间异丙酚的药代动力学参数比较差异无统计学意义(P>0．05)。结论TCI异丙酚药代动力学绝大部分适合用三室模型,小部分适合用二室模型来描述;梗阻性黄疸对异丙酚的药代动力学没有影响。更多还原

【Abstract】 Objective To compare the pharmacokinetic profile of propofol administered by target-controlled infusion (TCI) during anesthesia in patients with and without obstructive jaundice. Methods Twenty-four ASAⅠorⅡpatients aged 40-65 yrs weighing 50-75 kg undergoing elective surgery under general anesthesia were divided into 3 groups (n = 8 each) : group A control (serum total bilirubin <17.1μmol·L-1); group B mild obstructive jaundice (sTBL = 17.1-171.1μmol·L-1) and group C moderate and severe obstructive jaundice (sTBL > 171.1μmol·L-1) . Each group received propofol by TCI using Graseby 3500 infusion pump, based on pharmacokinetic parameter set published by Marsh. The target plasma concentration of propofol was set at 3μg·ml-1 . TCI of propofol was started from the induction of anesthesia and maintained until the end of the surgery. Arterial blood samples were taken at 0.5, 1, 2, 4, 6, 8 min after TCI of propofol was started and every 15 min during maintenance of anesthesia and at 2, 4, 6, 8, 10, 20, 30, 40, 50, 60, 90, 120, 180, 240 and 300 min after TCI was terminated. Plasma concentrations of propofol were determined by high-performance liquid chromatography (HPLC) with fluorescence detector. NONMEM was used to analyze the pharmacokinetic parameters. Results The 3 groups were comparable with respect to sex ratio, age and body weight. The pharmacokinetic profile of propofol given by TCI was best described by three-compartment open pharmacokinetic model in the majority of patients and by two-compartment open pharmacokinetic model in a few patients. There were no significant differences in the pharmacokinetic profile of propofol among the 3 groups. Conclusion Obstructive jaundice does not affect the pharmacokinetics of propofol.更多还原