Mertens M J, Engbers F H M, Burm A G L, Vuyk J
Department of Anaesthesiology, Leiden University Medical Centre, PO Box 9600, NL-2300 RC Leiden, The Netherlands.
Br J Anaesth. 2003 Feb;90(2):132-41. doi: 10.1093/bja/aeg046.
The predictive performance of the available pharmacokinetic parameter sets for remifentanil, when used for target-controlled infusion (TCI) during total i.v. anaesthesia, has not been determined in a clinical setting. We studied the predictive performance of five parameter sets of remifentanil when used for TCI of remifentanil during propofol anaesthesia in surgical patients.
Remifentanil concentration-time data that had been collected during a previous pharmacodynamic interaction study in 30 female patients (ASA physical status I, aged 20-65 yr) who received a TCI of remifentanil and propofol during lower abdominal surgery were used in this evaluation. The remifentanil concentrations predicted by the five parameter sets were calculated on the basis of the TCI device record of the infusion rate-time profile that had actually been administered to each individual. The individual and pooled bias [median performance error (MDPE)], inaccuracy [median absolute performance error (MDAPE)], divergence and wobble of the remifentanil TCI device were determined from the pooled and intrasubject performance errors.
A total of 444 remifentanil blood samples were analysed. Blood propofol and remifentanil concentrations ranged from 0.5 to 11 micro g ml(-1) and 0.1 to 19.6 ng ml(-1) respectively. Pooled MDPE and MDAPE of the remifentanil TCI device were -15 and 20% for the parameter set of Minto and colleagues (Anesthesiology 1997; 86: 10-23), 1 and 21%, -6 and 21%, and -6 and 19% for the three parameter sets described by Egan and colleagues (Anesthesiology 1996; 84: 821-33, Anesthesiology 1993; 79: 881-92, Anesthesiology 1998; 89: 562-73), and -24 and 30% for the parameter set described by Drover and Lemmens (Anesthesiology 1998; 89: 869-77).
Remifentanil can be administered by TCI with acceptable bias and inaccuracy. The three pharmacokinetic parameter sets described by Egan and colleagues resulted in the least bias and best accuracy.
在全静脉麻醉期间用于瑞芬太尼靶控输注（TCI）时，现有瑞芬太尼药代动力学参数集的预测性能尚未在临床环境中得到确定。我们研究了五种瑞芬太尼参数集在外科手术患者丙泊酚麻醉期间用于瑞芬太尼TCI时的预测性能。
本评估使用了之前在30名女性患者（美国麻醉医师协会身体状况I级，年龄20 - 65岁）进行下腹部手术期间接受瑞芬太尼和丙泊酚TCI的药效学相互作用研究中收集的瑞芬太尼浓度 - 时间数据。根据实际给予每个个体的输注速率 - 时间曲线的TCI设备记录，计算五种参数集预测的瑞芬太尼浓度。从汇总和个体内性能误差中确定瑞芬太尼TCI设备的个体和汇总偏差[中位性能误差（MDPE）]、不准确性[中位绝对性能误差（MDAPE）]、离散度和摆动度。
共分析了444份瑞芬太尼血样。血中丙泊酚和瑞芬太尼浓度分别为0.5至11μg/ml和0.1至19.6 ng/ml。对于Minto及其同事的参数集（《麻醉学》1997年；86：10 - 23），瑞芬太尼TCI设备的汇总MDPE和MDAPE分别为 - 15%和20%；对于Egan及其同事描述的三个参数集（《麻醉学》1996年；84：821 - 33，《麻醉学》1993年；79：881 - 92，《麻醉学》1998年；89：562 - 73），分别为1%和21%、 - 6%和21%以及 - 6%和19%；对于Drover和Lemmens描述的参数集（《麻醉学》1998年；89：869 - 77），分别为 - 24%和30%。
瑞芬太尼可通过TCI给药，偏差和不准确性可接受。Egan及其同事描述的三种药代动力学参数集偏差最小且准确性最佳。
