丙泊酚及靶控输注系统课件.pptx

1、Steven Shafer (史蒂文宪佛)Editor-in-Chief, Anesthesia & Analgesia (总编辑，麻醉与镇痛)Professor of Anesthesia, Stanford University (麻醉教授, 斯坦福大学)Ive consulted for propofol(我为丙泊酚做过顾问) AstraZenecaIve consulted for remifentanil(我为瑞芬太尼做顾问) Glaxo, AbbottIve consulted for companies interested in TCI(我为对靶控输注系统感兴趣的公司顾问) A

2、laris, B Braun, Medex容积 =药量药量浓度容积容积浓度数额 血浆新陈代谢器官清除 =药物完全被去除所需的血浆流速The time required for drug concentrations to decrease by 50%.(药物浓度降低50所需的时间)分布容积清除单次给药后的时程（分钟） 0120240360480600浓度 110100中间慢迅速半衰期芬太尼阿芬太尼舒芬太尼迅速111中间191323慢475111562单次给药后的时程（分钟） 0120240360480600阿片药物浓度占峰值浓度的百分比0.1110100芬太尼舒芬太尼阿芬太尼浓度降低50所需

3、的时间（分钟）单次给药后的时程（分钟）03060901200120240360480600芬太尼阿芬太尼舒芬太尼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 浓度降低50所需的时间（分钟）静脉输注时间清醒所需时间麻醉时间5067丙泊酚减少量6080异氟醚减少量03060901200120240360480600Duration of AnesthesiaMinutes Required for EmergenceSchnider et al, Anesthesiology

4、1998;88:1170-82111221331110121321 1222131 13331xCVdxx kx kxkkkdtdxx kx kdtdxx kx kdt注射 Biological variability exists(生物变异性的存在)TCI devices cannot increase biological variability(靶控输注系统不增加生物变异性)TCI removes time as a confounding variable between the device setting and the patient response(靶控输注系统去除了时间这一

5、存在于设备设置和病人反应之间的混杂变量)TCI can incorporate patient covariates to individualize drug dosing(靶控输注系统可以结合个体因素，实施个体化给药): Weight, height, gender, ethnicity (体重, 身高， 性别, 种族) Diseases (疾病) Drug interactions (药物之间相互作用) Pharmacogenetics (药物基因组学)STANPUMP 靶控输注系统(Shafer, Stanford)01020304050600246810芬太尼浓度(ng/ml)唤醒患

6、者缝皮稳态调整剂量切皮等待术前诱导 血浆时间(分钟) IV2k12V1k13V3迅速平均室 k21中央室 k31迅速平均室 k10效应部位Ve静脉注射 k1eke0芬太尼浓度(ng/ml)唤醒患者01020304050600246810 效应部位 血浆时间(分钟)缝皮稳态调整剂量切皮等待术前诱导010203040506002468103040 效应部位芬太尼浓度(ng/ml)唤醒患者 血浆时间(分钟)缝皮稳态调整剂量切皮诱导01020304050600246丙泊酚浓度(mcg/ml)唤醒患者时间(分钟)缝皮稳态调整剂量切皮等待术前诱导01020304050600246丙泊酚浓度唤醒患者时间(分

7、钟)(mcg/ml)缝皮稳态调整剂量切皮等待术前诱导Conscious/Unconscious Prediction (Pk)(意识清楚/无意识的预测)Glass et al, Anesthesiology 86:836-847, 1997Agent (n)BISTarget 浓度Measured 丙泊酚 (399)0.976*0.9360.937异氟醚(70)0.9590.9650.967咪唑安定 (50)0.8850.8590.886Significantly different from Pk value for Target Concentration (p 0.001),and Me

8、asured concentration (p 0.01)浓度Mathematical models of drug behavior incorporating effect site concentrations and drug interactions predict anesthetic drug effect (e.g., loss of response to stimulation) as well as:(结合了效应部位浓度和药物相互作用的药物行为学数学模型可以用来预测药物的效应(例如, 对刺激反应的丧失)，如同下列指标:Measured concentrationsBISA

9、AI（Auditory Evoked Potential）RUGLOOP(De Smet, Struys,Ghent)BIS020406080100BISerror-30-20-100102030SYS020406080100120140160Time (s)020004000600080001000012000HR020406080100Struys et al, Anesthesiology. 95:6-17, 2001BIS020406080100BISerror-30-20-100102030SYS020406080100120140160Time (s)020004000600080

10、001000012000HR020406080100BIS020406080100BISerror-30-20-100102030SYS020406080100120140160Time (s)020004000600080001000012000HR020406080100BIS020406080100BISerror-30-20-100102030SYS020406080100120140160Time (s)020004000600080001000012000HR020406080100BISSystolicHeart Rateclosed-loop controlclassic-co

11、ntrol 闭合回路控制 标准控制Over 500 peer-reviewed articles in Medline as of September 2006(至2006 年9月，Medline有超过500篇相关的同行评论文章)Approved everywhere except in the US(除美国以外均可使用)全世界应用靶控输注系统世界使用靶控输注系统药量指南药量指南TIVA丙泊酚 3-5 g/ml瑞芬太尼 2-6 ng/mlTIVAN氧化亚氮: 65-70%丙泊酚 at 2.5-3.5 g/ml瑞芬太尼 at 2-6 ng/mlProfessor Shuren LiPreside

12、nt, Chinese Society of AnesthesiologistsProfessor Yun YueProfessor and Chairman, Beijing Chaoyang HospitalDr. Yuguang HuangScientific Director, Chinese Language Edition, Anesthesia & AnalgesiaEdith Huang AstraZeneca Pharmaceutical Co., Ltd.Dr. Xi Hong Translator of slides and presentationLaura Freyberg Neighbor, dear friend, and translation assistance in US谢谢