Luo Ai-lun, Yi Jie, Guo Xiang-yang, Ren Hong-zhi, Huang Yu-guang, Ye Tie-hu
Department of Anesthesiology, Peking Union Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China.
Chin Med J (Engl). 2004 Feb;117(2):231-4.
Although the performance of target-controlled infusion (TCI) have been studied extensively, the accuracy and safety of a TCI system that targets the effect site remains to be demonstrated. This study was to investigate the relations of TCI of propofol to its concentrations in cerebral spinal fluid (CSF), the effect-site concentrations and bispectral index (BIS).
Twelve mongrel dogs were used for investigations. The target effect-site concentration was set at 3 microg/ml and the infusion was lasted for 15 minutes. CSF and blood samples were then collected and propofol concentrations were determined by using high performance liquid chromatography with fluorescence detection. BIS and hemodynamic data were monitored continuously.
The predicted plasma concentrations were generally overestimated. Median performance error (MDPE) and absolute median performance error (MDAPE) were -10.0% and 29.9% respectively. Propofol CSF concentrations were much lower than its effect-site concentrations. Changes in BIS were consistent with propofol concentrations in CSF, both of which changed direction at 5 minutes while the effect-site concentrations relatively lagged behind. Better correlation (r(2) = 0.9195) was found between BIS and CSF concentrations, when compared with that between BIS and effect-site concentrations (r(2) = 0.554).
With 1% enflurane inhaled, the inconsistency of drug effect to the effect-site concentrations may result from inaccuracy of pharmacokinetic parameters. CSF may show effect-site concentrations more accurately than plasma when using target effect-site concentration infusion.
尽管靶控输注（TCI）的性能已得到广泛研究，但以效应室为靶点的TCI系统的准确性和安全性仍有待证实。本研究旨在探讨丙泊酚TCI与其脑脊液（CSF）浓度、效应室浓度及脑电双频指数（BIS）之间的关系。
选用12只杂种犬进行研究。将目标效应室浓度设定为3μg/ml，输注持续15分钟。然后采集脑脊液和血液样本，采用高效液相色谱荧光检测法测定丙泊酚浓度。持续监测BIS和血流动力学数据。
预测的血浆浓度普遍被高估。中位性能误差（MDPE）和绝对中位性能误差（MDAPE）分别为-10.0%和29.9%。丙泊酚脑脊液浓度远低于其效应室浓度。BIS的变化与脑脊液中丙泊酚浓度一致，两者均在5分钟时改变方向，而效应室浓度相对滞后。与BIS和效应室浓度之间的相关性（r² = 0.554）相比，BIS与脑脊液浓度之间的相关性更好（r² = 0.9195）。
吸入1%安氟醚时，药物效应与效应室浓度不一致可能是由于药代动力学参数不准确所致。在使用目标效应室浓度输注时，脑脊液可能比血浆更准确地反映效应室浓度。
