住院医师入科培训：22 靶控输注 TCI

1、 Pharmacokinetic properties of Diprivan (propofol) Open, three-compartment model Effect compartment Central compartment 1 V1 Elimination k10 k12 k21 Second compartment 2 k13 k31 Third compartment 3 keo Drug equilibrates between and within compartments Intravenous infusion k1e 单次注药后三室模型的血浆浓度变化单次注药后三室

2、模型的血浆浓度变化 在快速分布相，药物从中央室（V1）向快速周边室（V2）、慢速周边室(V3)和体外转运。 在慢速分布相，药物从V2向V1，以及从V1向V3和体外转运。在终末相，药物从V2和V3向 V1转运，从V1排出 return TCI的评价指标的评价指标 100% Cp CpCm PE TCI的评价指标的评价指标 计算浓度 实测浓度 无偏离有意义偏离 偏离性偏离性- -执行误差的中位数（执行误差的中位数（MDPE）表示）表示 TCI的评价指标的评价指标 计算浓度 实测浓度 精确度精确度- -执行误差绝对值的中位数（执行误差绝对值的中位数（MDAPE）表示）表示 分散小分散小 (No Bi

3、as) 分散大分散大 (No Bias） TCI的评价指标的评价指标 TCI系统的组成部分 Vc V2V1 药代动力学模型 的种类 病人 身高、体重、性别、 年龄 医生选择的用药模式和靶浓度 注射泵或输注系统 内含药代学程内含药代学程 序的微处理器序的微处理器 几种常见的TCI注射泵 Graseby 3500泵泵 ALARIS IVAC TIVA TCI泵泵 信息键( 效应部位浓度、达到靶浓度 的时间 ) 微调微调 输入得普利麻的总量 TCI 模式提示 TCI 模式提示 靶血药浓度 计算的血药浓度 液晶显示 Consult Instruction Manual for details of d

4、isplay and operation Consult Directions for Use for details of display and operation 调节键计算浓度的趋势图 效应部位浓度得普利麻输注量泵工作状态计算的血药浓度 靶血药浓度 预计的清醒 时间 Consult pump manufacturer for detailed specification Consult full, local prescribing information 25% 50% 75% 100% 靶血药浓度靶血药浓度 n = 20n = 20n = 20 40% 75% 90% 3 g/ml

5、 4 g/ml 5 g/ml Chaudhri S et al. 1992 Failure of induction (patients not induced within 3 minutes of achieving the target concentration): target increased to 6 g/ml 成功诱导的百分比 20406080 Diprifusor TCI n = 79 人工控制输注人工控制输注 n = 80 55 75 (SD 10.6) (SD 18.8) p 0.01 平均诱导时间 (seconds) Russell D et al. 1995 The

6、 initial infusion rate was higher with Diprifusor TCI (1,200 ml/h) than with manual control (600ml/h). The mean dose of Diprivan administered at the time of insertion of the laryngeal mask air way was significantly higher (p 0.05) with Diprifusor TCI (201 mg) than with manual control (160 mg) UK 的研究

7、， ASA I or II 级病人 Hutton P et al. 1995 The initial infusion rate was higher with Diprifusor TCI (1,200 ml/h) than with manual control (600 ml/h). The mean dose of Diprivan administered at the time of insertion of the laryngeal mask air way was significantly higher (p 55 years3.5 g/ml 2.8 to 3.4 g/ml 3.5 to 5.3 g/ml Hutton P et al. 1995 The initial infusion rate was higher with Diprifusor TCI (1,200 ml/h) than with manual control (600 ml/h). The mean dose of Diprivan administered at the time of insertion of the laryngeal mask air way was signifi