丙泊酚靶控输注准确性的研究进展

Research Progress of the Accuracy of Propofol Target-controlled Infusion

关键词:  丙泊酚  药动学  靶控输注  准确性  执行误差

Key words:  propofol  pharmacokinetic  target-controlled infusion  accuracy  performance error

摘要:

靶控输注（target-controlled infusion，TCI）是一种计算机控制的药物输注技术，是根据药动学参数计算维持靶浓度的药物输注速度。丙泊酚TCI广泛用于临床麻醉，可对绝大多数患者进行较为准确的麻醉，但有些情况下TCI系统并不能精准预测实际血药浓度，进而影响医师对实际药物浓度的判断，对患者产生不良影响。结合近年文献，本文就影响丙泊酚TCI准确性的因素做一综合阐述。从药动学模型的选择、个体间药动学的差异和围术期病理生理改变3个方面阐述影响丙泊酚TCI准确性的因素，以提醒麻醉医师关注特定情况下患者丙泊酚药动学的差异，警惕因TCI给药偏差所带来的不良反应，根据相关监测指标调整丙泊酚用药浓度和用药方案。

Abstract:

Target-controlled infusion(TCI) is a computer-controlled drug infusion technique that calculates the rate of drug infusion to maintain target concentration based on pharmacokinetic parameters. Propofol TCI is widely used in clinical anesthesia, and can perform relatively accurate anesthesia for majority patients. However, in some cases, the TCI system can't accurately predict the actual plasma concentration, which in turn affects the doctor's judgment on the actual plasma concentration. The effects of propofol TCI accuracy on the choice of pharmacokinetic model, the difference of inter-individual pharmacokinetics and the change of perioperative pathophysiological state are noted to remind anesthesiologists to the difference in the pharmacokinetics of propofol in these situations. The anesthesiologist should be alert to the adverse reactions caused by the deviation of TCI administration, and adjust the target concentration and medication regimen according to other monitoring indicators.