Ko Yuan-Pi, Hsu Yung-Wei, Hsu Kuei, Tsai Hsin-Jung, Huang Chun-Jen, Chen Chien-Chuan
Department of Anesthesiology, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan, ROC.
Acta Anaesthesiol Taiwan. 2007 Sep;45(3):141-7.
The performance of target-controlled infusion (TCI) devices is important for the safety of patients. This study examined the performance of two propofol pharmacokinetic parameter sets in Chinese patients by computer simulation.
Two sets of propofol pharmacokinetic parameters respectively derived from Marsh's and Schnider's studies were compared with those obtained in Chinese subjects from Li's study. Pharmacokinetic parameters of propofol from Li's study for subjects of three different entities (average adult, obese adult, and elderly) were used to estimate the performance of Marsh's and Schnider's models. Sixty virtual patients were generated with Li's parameters. A computer program, STANPUMP, was used to perform the pharmacokinetic simulation. An induction dose of propofol at 2 mg/kg for average or obese adult, while 1.5 mg/kg for the elderly, followed by TCI of 4 microg/mL (average and obese adult) or 3 microg/mL (elderly) were simulated. The infusion schemes generated by STANPUMP using Marsh's or Schnider's model were put in to simulate the predicted plasma concentration based on the pharmacokinetic parameters from Li's study. The median performance error (MDPE) and absolute median performance error (MDAPE) were calculated to estimate the bias and inaccuracy. Differences between models were calculated using the paired t test. A P value < 0.05 was considered statistically significant.
The bias and inaccuracy by Marsh's model in average adults were -11.9% and 18.5% respectively and by Schnider's model were -8.6% and 17.9%. For obese adults, the bias and inaccuracy were 6.3% and 26.2% respectively for Marsh's model and -6.6% and 22.6% for Schnider's model. Sohnider's model resulted in a significantly greater inaccuracy than Marsh's model (42.1% versus 15.5%) when applied to elderly patients.
The performance of TCI infusion of propofol in Chinese patients is generally acceptable with Marsh's or Schnider's model apart from using Schnider's model in Chinese elderly patients. Further study to investigate the difference of propofol pharmacokinetics between Chinese and non-Chinese elderly patients is necessary.
靶控输注（TCI）设备的性能对患者安全至关重要。本研究通过计算机模拟考察了两组丙泊酚药代动力学参数集在中国患者中的性能。
将分别源自马什（Marsh）研究和施奈德（Schnider）研究的两组丙泊酚药代动力学参数与从李的研究中获得的中国受试者的参数进行比较。使用李的研究中针对三种不同类型受试者（平均成年人、肥胖成年人和老年人）的丙泊酚药代动力学参数来评估马什模型和施奈德模型的性能。用李的参数生成60名虚拟患者。使用计算机程序STANPUMP进行药代动力学模拟。模拟平均或肥胖成年人诱导剂量的丙泊酚为2mg/kg，老年人为1.5mg/kg，随后平均和肥胖成年人以4μg/mL、老年人以3μg/mL进行靶控输注。将STANPUMP使用马什模型或施奈德模型生成的输注方案用于根据李的研究中的药代动力学参数模拟预测的血浆浓度。计算中位性能误差（MDPE）和绝对中位性能误差（MDAPE）以评估偏差和不准确性。使用配对t检验计算模型之间的差异。P值<0.05被认为具有统计学意义。
马什模型在平均成年人中的偏差和不准确性分别为-11.9%和18.5%，施奈德模型为-8.6%和17.9%。对于肥胖成年人来说，马什模型的偏差和不准确性分别为6.3%和26.2%，施奈德模型为-6.6%和22.6%。当应用于老年患者时，施奈德模型导致的不准确性显著高于马什模型（42.1%对15.5%）。
除了在中国老年患者中使用施奈德模型外，马什模型或施奈德模型用于中国患者的丙泊酚靶控输注性能总体上是可接受 的。有必要进一步研究中国老年患者与非中国老年患者丙泊酚药代动力学的差异。
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