出血对丙泊酚伪稳态浓度的影响。

Influence of hemorrhage on propofol pseudo-steady state concentration.

作者信息

Kazama Tomiei, Kurita Tadayoshi, Morita Koji, Nakata Jun, Sato Shigehito

机构信息

Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Japan.

出版信息

Anesthesiology. 2002 Nov;97(5):1156-61. doi: 10.1097/00000542-200211000-00020.

DOI:10.1097/00000542-200211000-00020

PMID:12411801

Abstract

BACKGROUND

A small induction dose has been recommended in cases of hemorrhagic shock. However, the influence of hemorrhage on the amplitude of plasma propofol concentration has not yet been fully investigated during continuous propofol infusion. The authors hypothesized that the effect of hemorrhage on plasma propofol concentration is variously influenced by the different stages of shock.

METHODS

After 120 min of steady state infusion of propofol at a rate of 2 mg x kg(-1) x h(-1), nine instrumented immature swine were studied using a stepwise increasing hemorrhagic model (200 ml of blood every 30 min until 1 h, then additional stepwise bleeding of 100 ml every 30 min thereafter, to the point of circulatory collapse). Hemodynamic parameters and plasma propofol concentration were recorded at every step.

RESULTS

Before total circulatory collapse, it was possible to drain 976 +/- 166 ml (mean +/- SD) of blood. Hemorrhage of less than 600 ml (19 ml/kg) was not accompanied by a significant change in plasma propofol concentration. At individual peak systemic vascular resistance, when cardiac output and mean arterial pressure decreased by 31% and 14%, respectively, plasma propofol concentration increased by 19% of its prehemorrhagic value. At maximum heart rate, when cardiac output and mean arterial pressure decreased by 46% and 28%, respectively, plasma propofol concentration increased by 38%. In uncompensated shock, it increased to 3.75 times its prehemorrhagic value.

CONCLUSIONS

During continuous propofol infusion, plasma propofol concentration increased by less than 20% during compensated shock. However, it increased 3.75 times its prehemorrhagic concentration during uncompensated shock.

摘要

背景

对于失血性休克患者，已建议采用小剂量诱导麻醉。然而，在持续输注丙泊酚期间，出血对血浆丙泊酚浓度幅度的影响尚未得到充分研究。作者推测，休克的不同阶段对出血对血浆丙泊酚浓度的影响存在差异。

方法

以2 mg·kg⁻¹·h⁻¹的速率对丙泊酚进行120分钟的稳态输注后，使用逐步增加失血量的模型（每30分钟失血200 ml，持续1小时，此后每30分钟额外逐步失血100 ml，直至循环衰竭）对9头植入监测仪器的未成年猪进行研究。在每个步骤记录血流动力学参数和血浆丙泊酚浓度。

结果

在完全循环衰竭前，可失血976±±166 ml（平均值±标准差）。失血量少于600 ml（19 ml/kg）时，血浆丙泊酚浓度无显著变化。在个体全身血管阻力峰值时，心输出量和平均动脉压分别下降31%和14%，血浆丙泊酚浓度比出血前值增加19%。在最大心率时，心输出量和平均动脉压分别下降46%和28%，血浆丙泊酚浓度增加38%。在失代偿性休克时，其增加至出血前值的3.75倍。