Raedschelders Koen, Hui Yu, Laferlita Bradley, Luo Tao, Zhang Hong, Chen David D Y, Ansley David M
Department of Anesthesiology, Pharmacology, and Therapeutics, The University of British Columbia, Rm 3200 3rd Floor, JPP. 910 West 10th Ave, Vancouver, BC V5Z 4E3, Canada.
Can J Anaesth. 2009 Sep;56(9):658-66. doi: 10.1007/s12630-009-9145-3. Epub 2009 Jul 29.
Propofol concentrations that produce laboratory-based cardioprotective effects are generally greater than those produced under routine anesthesia during cardiac surgery. It is unknown whether experimental cardioprotective propofol concentrations can routinely be achieved during cardiopulmonary bypass (CPB) using continuous infusion.
Twenty-four patients scheduled for primary aortocoronary bypass grafting with CPB were allocated to receive one of three propofol infusion rates; 50, 100, or 150 microg x kg(-1) x min(-1) in an open-label pilot study. Data were described using a line of best fit to derive an experimental clinical maneuver predicted to produce a whole blood concentration of 5 microg x mL(-1) at reperfusion. A predetermined interim analysis of 30 patients who were receiving the derived maneuver in an ongoing study was used to evaluate the maneuver. Cardiac index (CI), systemic vascular resistance index (SVRI), and left ventricular stroke work index (LVSWI) were recorded.
The infusion rate-concentration curve had an equation of y = 0.215e (0.0279x ), where y represents the whole blood concentration and x represents the infusion rate (r (2) = 0.781). The predicted infusion rate to achieve a mean concentration of 5 microg x mL(-1) was 113 microg x kg(-1) x min(-1). The nearest practical rate is 120 microg x kg(-1) x min(-1), producing a concentration of 5.39 (1.45) microg x mL(-1). The values for CI, SVRI, and LVSWI were similar between groups at corresponding time periods.
An infusion rate of 120 microg x kg(-1) x min(-1) is clinically practical and capable of achieving experimental cardioprotective propofol concentrations at reperfusion.
产生基于实验室的心脏保护作用的丙泊酚浓度通常高于心脏手术常规麻醉期间的浓度。目前尚不清楚在体外循环（CPB）期间使用持续输注能否常规达到具有实验性心脏保护作用的丙泊酚浓度。
在一项开放标签的初步研究中，将24例计划进行CPB下初次主动脉冠状动脉搭桥术的患者分配接受三种丙泊酚输注速率之一；50、100或150微克·千克⁻¹·分钟⁻¹。使用最佳拟合线描述数据，以得出预计在再灌注时产生5微克·毫升⁻¹全血浓度的实验性临床操作。在一项正在进行的研究中，对30例接受该推导操作的患者进行预定的中期分析，以评估该操作。记录心脏指数（CI）、全身血管阻力指数（SVRI）和左心室每搏功指数（LVSWI）。
输注速率-浓度曲线的方程为y = 0.215e（0.0279x），其中y代表全血浓度，x代表输注速率（r² = 0.781）。达到平均浓度5微克·毫升⁻¹的预测输注速率为113微克·千克⁻¹·分钟⁻¹。最接近的实际速率为120微克·千克⁻¹·分钟⁻¹，产生的浓度为5.39（1.45）微克·毫升⁻¹。相应时间段内各组间CI、SVRI和LVSWI的值相似。
120微克·千克⁻¹·分钟⁻¹的输注速率在临床上可行，并且能够在再灌注时达到具有实验性心脏保护作用的丙泊酚浓度。
