老年体外循环辅助心脏手术全身麻醉诱导中丙泊酚与依托咪酯的相互作用和配伍方案优化

doi:10.3969/j.issn.1003-9198.2024.12.016

摘要/Abstract

摘要： 目的应用响应曲面分析丙泊酚与依托咪酯在老年体外循环辅助心脏手术全身麻醉诱导中的相互作用,并探究靶控输注丙泊酚与依托咪酯的最佳配伍剂量。方法选取2019年9月至2022年1月于南京鼓楼医院接受体外循环辅助心脏手术并行静脉全身麻醉诱导的老年病人200例作为研究对象,选择丙泊酚与依托咪酯靶控输注起始配伍浓度,主要观察病人麻醉后的脑电双频指数(BIS)、平均动脉压(MAP)、心率(HR)及意识消失时间(T_LOC)。应用响应曲面模型分析丙泊酚与依托咪酯在老年心脏手术麻醉诱导中的药效学相互作用,并计算最佳配伍浓度范围。结果响应曲面模型显示,丙泊酚与依托咪酯在老年心脏手术全身麻醉诱导过程中对体动反应和循环反应具有显著协同作用,靶控输注丙泊酚浓度为3.10 μg/mL时,依托咪酯最佳配伍浓度范围为0.22 μg/mL;靶控输注丙泊酚浓度为3.20 μg/mL时,依托咪酯浓度为0.15～0.20 μg/mL;靶控输注丙泊酚浓度为3.30 μg/mL时,依托咪酯浓度为0.15～0.18 μg/mL;靶控输注丙泊酚浓度为3.40 μg/mL时,依托咪酯浓度为0.16～0.17 μg/mL。结论丙泊酚与依托咪酯镇静药效呈协同作用,在不同的药效反应相结合创建出的丙泊酚与依托咪酯最佳配伍剂量范围内可以为病人提供良好的麻醉效果。

关键词: 依托咪酯, 丙泊酚, 响应曲面模型, 心脏手术, 相互作用, 最佳配伍剂量

Abstract: Objective To analyze the interaction between propofol and etomidate in general anesthesia induction in the elderly patients undergoing cardiopulmonary bypass assisted cardiac surgery through response surface methodology, and to explore the optimal compatibility concentration of target controlled infusion of propofol and etomidate. Methods A total of 200 elderly patients who undergoing extracorporeal circulation assisted cardiac surgery and intravenous general anesthesia induction in Nanjing Drum Tower Hospital from September 2019 to January 2022 were enrolled in this study. The starting concentration of propofol and etomidate target controlled infusion was selected, and the post anesthesia bispectral index (BIS), mean arterial pressure (MAP), heart rate (HR), and time to loss of consciousness (T_LOC) were observed. Response surface modeling was applied to analyze the pharmacodynamic interaction between propofol and etomidate in anesthesia induction for elderly cardiac surgery, and the optimal concentration range for compatibility was calculated. Results The response surface model showed that propofol and etomidate had a significant synergistic effect on the body movement reaction and circulatory responses during general anesthesia induction in the elderly patients undergoing cardiac surgery. When the concentration of target controlled infusion of propofol was 3.10 μg/mL, the optimal concentration range of etomidate was 0.22 μg/mL; When the concentration of propofol in target controlled infusion was 3.20 μg/mL, the optimal concentration range of etomidate was 0.15-0.20 μg/mL; When the concentration of propofol in target controlled infusion was 3.30 μg/mL, the optimal concentration range of etomidate was 0.15-0.18 μg/mL; When the concentration of propofol in target controlled infusion was 3.40 μg/mL, the optimal concentration of etomidate was 0.16-0.17 μg/mL. Conclusions Propofol and etomidate have a synergistic sedative effect, and the combination of different pharmacological reactions creates the optimal compatibility concentration for propofol and etomidate, which can provide good anesthesia effects.

Key words: etomidate, propofol, response surface model, cardiac surgery, interaction, optimal compatibility concentration

中图分类号:

R 614.2

吴雄, 顾小萍. 老年体外循环辅助心脏手术全身麻醉诱导中丙泊酚与依托咪酯的相互作用和配伍方案优化[J]. 实用老年医学, 2024, 38(12): 1260-1265.

WU Xiong, GU Xiaoping. Interaction and compatibility optimization of propofol and etomidate in general anesthesia induction of elderly patients undergoing cardiopulmonary bypass assisted cardiac surgery[J]. Practical Geriatrics, 2024, 38(12): 1260-1265.

参考文献

[1] CHEN E Y, MICHEL G, ZHOU B, et al. An analysis of anesthesia induction dosing in female older adults[J]. Drugs Aging, 2020, 37(6): 435-446.
[2] BOE¨X C, GOGA C, BÉRARD N, et al. Intraoperative subcortico-cortical evoked potentials of the visual pathway under general anesthesia[J]. Clin Neurophysiol, 2021, 132(7): 1381-1388.
[3] LO A, NORCLIFFE-KAUFMANN L, VICKERY R, et al. Pharmacokinetics and pharmacodynamics of ampreloxetine, a novel, selective norepinephrine reuptake inhibitor, insymptomatic neurogenic orthostatic hypotension[J]. Clin Auton Res, 2021, 31(3): 395-403.
[4] LIANG Z, XU X, QI X, et al. Efficacy and safety of ulinastatin on cognitive dysfunction after general anesthesia in elderly patients:a protocol for systematic review and meta-analysis[J]. Medicine: Baltimore, 2021, 100(13): e24814.
[5] CHEN T, YASEN Y, WU J, et al. Factors influencing lower respiratory tract infection in older patients after general anesthesia[J]. J Int Med Res, 2021, 49(9): 3000605211043245.
[6] LING Y, GAO H, WANG J, et al. Effects of dexmedetomidine and ACE genotype on cardiovascular response during the decannulation period of general anesthesia in patients with essential hypertension[J]. Clin Ther, 2020, 42(10): 1992-2000.
[7] HUMENIUK R, MATHIAS A, KIRBY B J, et al. Pharmacokinetic, pharmacodynamic, and drug-interaction profile of remdesivir, a SARS-CoV-2 replication inhibitor[J]. Clin Pharmacokinet, 2021, 60(5): 569-583.
[8] IRO C M, HAMATI R, EL MANSARI M E, et al. Repeated but not single administration of ketamine prolongs increases of the firing activity of norepinephrine and dopamine neurons[J]. Int J Neuropsychopharmacol, 2021, 24(7): 570-579.
[9] 杨璐, 魏滨, 张利萍, 等. 应用响应曲面模型法研究丙泊酚与瑞芬太尼的最佳配伍剂量[J].中国临床药理学与治疗学, 2020, 25(4): 413-420.
[10] 王晓伟, 孙天胜, 张建政, 等. 美国麻醉医师协会分级对老年髋部骨折患者预后的预测作用[J]. 中华创伤杂志, 2020, 36(1): 51-57.
[11] MOHR N M, PAPE S G, DAN R, et al. Etomidate use is associated with less hypotension than ketamine for emergency department sepsis intubations: a NEAR cohort study[J]. Acad Emerg Med, 2020, 27(11): 1140-1149.
[12] LI Z, CAI J, LI J, et al. Comparative evaluation of the bispectral index (BIS) and BISpro during propofol anaesthesia[J]. J Int Med Res, 2021, 49(4): 3000605211001705.
[13] DAI G, PEI L, DUAN F, et al. Safety and efficacy of remimazolam compared with propofol in induction of general anesthesia[J]. Minerva Anestesiol, 2021, 87(10): 1073-1079.
[14] JONES T L, CALBAY R, DA CUNHA A F, et al. Descriptive assessment of adverse events associated with midazolam-etomidate versus saline-etomidate in healthy hydromorphone premedicated dogs[J]. J Small Anim Pract, 2021, 62(6): 437-441.
[15] YU J S, LOUER R, LUTFI R, et al. Adjuvant lidocaine to a propofol-ketamine-based sedation regimen for bone marrow aspirates and biopsy in the pediatric population[J]. Eur J Pediatr, 2021, 180(1): 73-80.
[16] YANG Y, SONG C, SONG C, et al. Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section[J]. Exp Ther Med, 2020, 19(3): 1747-1754.
[17] LIU G L, CUI Y F, LU C, et al. Ketamine a dissociative anesthetic:neurobiology and biomolecular exploration in depression[J]. Chem Biol Interact, 2020, 319: 109006.
[18] HEFNER G, HAHN M, HIEMKE C, et al. Pharmacodynamic drug-drug interactions of QT-prolonging drugs in hospitalized psychiatric patients[J]. J Neural Transm:Vienna, 2021, 128(2): 243-252.
[19] MATCHETT G, GASANOVA I, RICCIO C A, et al. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial[J]. Intensive Care Med, 2022, 48(1): 78-91.