丙泊酚及靶控輸注系統(tǒng)課件

《丙泊酚及靶控輸注系統(tǒng)課件》由會(huì)員上傳分享，免費(fèi)在線閱讀，更多相關(guān)內(nèi)容在教育資源-天天文庫(kù)。

1、TCIandPropofol(丙泊酚及靶控輸注系統(tǒng))StevenShafer(史蒂文憲佛)Editor-in-Chief,Anesthesia&Analgesia(總編輯，麻醉與鎮(zhèn)痛)ProfessorofAnesthesia,StanfordUniversity(麻醉教授,斯坦福大學(xué))I’veconsultedforpropofol(我為丙泊酚做過(guò)顧問(wèn))AstraZenecaI’veconsultedforremifentanil(我為瑞芬太尼做顧問(wèn))Glaxo,AbbottI’veconsultedforcompaniesinterestedinTCI(我為對(duì)靶控輸注系統(tǒng)感興趣

2、的公司顧問(wèn))Alaris,BBraun,MedexConflictofInterest(利益沖突)PharmacokineticConcepts(藥代動(dòng)力學(xué)概念)VolumeofDistribution(分布容積)容積數(shù)額Clearance(清除率)血漿新陳代謝器官清除=藥物完全被去除所需的血漿流速Half-Life(半衰期)Thetimerequiredfordrugconcentrationstodecreaseby50%.(藥物濃度降低50％所需的時(shí)間)OpioidPharmacokinetics(鴉片類製劑藥代動(dòng)力學(xué))單次給藥后的時(shí)程（分鐘）0120240360480600阿片藥

3、物濃度占峰值濃度的百分比0.1110100芬太尼舒芬太尼阿芬太尼Context-SensitiveHalf-Time(時(shí)效相關(guān)半衰期)濃度降低50％所需的時(shí)間（分鐘）單次給藥后的時(shí)程（分鐘）03060901200120240360480600芬太尼阿芬太尼舒芬太尼PropofolPharmacokinetics(丙泊酚藥代動(dòng)力學(xué))50%effectsitedecrementcurves(效應(yīng)部位濃度50%衰減曲線)01202403604806000306090120芬太尼阿芬太尼舒芬太尼瑞芬太尼01202403604806000306090120咪唑安定硫噴妥鈉丙泊酚濃度降低50％所需的

4、時(shí)間（分鐘）靜脈輸注時(shí)間Propofol/opioidvs.isoflurane/opioid(丙泊酚/鴉片類製劑vs.異氟醚/鴉片類製劑)清醒所需時(shí)間麻醉時(shí)間50－67％丙泊酚減少量60－80％異氟醚減少量03060901200120240360480600DurationofAnesthesiaMinutesRequiredforEmergence丙泊酚藥代動(dòng)力學(xué)Schnideretal,Anesthesiology1998;88:1170-82TargetControlledInfusion靶控輸注系統(tǒng)TCISolvestheDifferentialEquationsforDrug

5、Concentration(靶控輸注系統(tǒng)解決了藥物濃度的微分方程)FirstGenerationTCI(第一代靶控輸注系統(tǒng))Target=Plasma(以血漿為靶部位)CATIA:第一靶控輸注系統(tǒng)(Schwildenetal,Bonn)“Diprifusor”第一商業(yè)靶控輸注系統(tǒng)…TCIVariability(靶控輸注系統(tǒng)的變異性)Biologicalvariabilityexists(生物變異性的存在)TCIdevicescannotincreasebiologicalvariability(靶控輸注系統(tǒng)不增加生物變異性)TCICanReduceVariability(靶控輸注系統(tǒng)

6、能減少變異性)TCIremovestimeasaconfoundingvariablebetweenthedevicesettingandthepatientresponse(靶控輸注系統(tǒng)去除了時(shí)間這一存在于設(shè)備設(shè)置和病人反應(yīng)之間的混雜變量)TCIcanincorporatepatientcovariatestoindividualizedrugdosing(靶控輸注系統(tǒng)可以結(jié)合個(gè)體因素，實(shí)施個(gè)體化給藥):Weight,height,gender,ethnicity(體重,身高，性別,種族)Diseases(疾病)Druginteractions(藥物之間相互作用)Pharmacog

7、enetics(藥物基因組學(xué))SecondGenerationTCI(第二代靶控輸注系統(tǒng))Target=EffectSite(效應(yīng)部位為靶部位)STANPUMP靶控輸注系統(tǒng)(Shafer,Stanford)01020304050600246810FentanylTCI,PlasmaTarget(芬太尼TCI，血漿為靶濃度)芬太尼濃度(ng/ml)喚醒患者縫皮穩(wěn)態(tài)調(diào)整劑量切皮等待術(shù)前誘導(dǎo)血漿時(shí)間(分鐘)Threecompartment