Heidegger T, Minto C F, Schnider T W
Institut für Anästhesiologie, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Anaesthesist. 2004 Jan;53(1):95-110. doi: 10.1007/s00101-003-0628-2.
From a pharmacological perspective, anesthesia is concerned with controlling the time course of drug effect. Mathematical models are commonly used to relate the administered drug dose to the measured drug concentration (a pharmacokinetic model) and to relate the measured drug concentrations to the measured drug effects (a pharmacodynamic model). With such models, the time course of the drug effect for different drug regimens can be predicted. Although the conventional pharmacokinetic parameters such as the volume of distribution, clearance, distribution and elimination half-lives can be used to accurately describe the time course of the plasma concentration, the plasma is usually not the site of drug effect. An understanding of the "effect compartment concept" and the "time of the peak effect site concentration," together with the concepts of" context sensitive"half-time and "relevant decrement time,' contribute substantially to the anesthetist's understanding of the principles governing the onset and offset of drug effect. As part of a computer-controlled infusion system, the pharmacokinetic model facilitates optimized and rational dosing. These systems, also called target-controlled infusion systems (TCI), calculate the infusion rates for rapidly achieving and then maintaining a target concentration.
从药理学角度来看，麻醉涉及控制药物效应的时间进程。数学模型通常用于将给药剂量与测得的药物浓度相关联（药代动力学模型），并将测得的药物浓度与测得的药物效应相关联（药效动力学模型）。利用这些模型，可以预测不同给药方案的药物效应时间进程。尽管传统的药代动力学参数，如分布容积、清除率、分布半衰期和消除半衰期，可用于准确描述血浆浓度的时间进程，但血浆通常不是药物作用的部位。对“效应室概念”和“效应部位浓度峰值时间”的理解，以及“上下文敏感”半衰期和“相关衰减时间”的概念，极大地有助于麻醉医生理解药物效应起效和消退的原理。作为计算机控制输注系统的一部分，药代动力学模型有助于优化和合理给药。这些系统，也称为靶控输注系统（TCI），计算输注速率以快速达到并维持目标浓度。
