TCI的理论与实践.ppt

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1、TCI的理论与实践BalancedAnesthesiaMusclerelaxationLossofConsciousnessAnalgesia全身麻醉静脉诱导吸入维持静脉诱导静脉维持静脉诱导吸入维持静脉维持静脉诱导吸入维持或静脉维持椎管内麻醉或神经阻滞全身麻醉TCI/TIVA的优点Controldepthofsedationpre-inductionLesspollutionintheOTandenvironmentNolivertoxicityLessPONVAccesstoairwayunrestrictedbydrugdeliver

2、yCanbecontinuedforpost-opsedationNoincreaseinF-ions;safewithsodalimeMaintainhypoxicvasoconstrictionreflexSafeinpatientsatriskformalignanthyperthermiaTCIsystem:predictsbloodandeffectsitecalculatedconcentrations,similartothewaythatend-tidalmonitormeasuresgasexhaledfromthepa

3、tientTCI的发展:Propofol给药方式手动给药Mg/kg持续输注Mg/kg/hrTCIPTCI/ETCIμg/mlClosedloopTCI?手动给药M,40yr,70kg,170cm.Propofolmanual:Effectsiteconcentration>2.8ug/ml2mg/kg1mg/kg1mg/kg1mg/kgPropofol:持续输注M,40yr,70kg,170cm.Propofolbolus+infusion:Effectsiteconcentration>2.8ug/ml2mg/kg8mg/kg/hrPr

4、opofol:TCIM,40yr,70kg,170cm.PropofolTCI3.5ug/mlPlasmaTCI3.5ug/mlEffectTCI3.5ug/mlTCI成功的理论和物质基础药物的进步：PropofolRemifentanilSufentanil丙泊酚和阿片类药物PK和PD:三室模式效应室EC50EC95封效应时间时量相关半衰期TCI泵双通道TCI泵麻醉深度监测仪（BIS）13Pharmacokineticmodelwith3compartments2132Pharmacokineticsetwitheffectsitec

5、ompartmentT1/2KeoPharmacokineticAndPharmacodynamicParametersOfPropofolAndTheOpioidsBart-JanLichtenbelt,etal.ClinPharmacokinet2004;43(9):577-593TimeToPeakEffectContextSensitiveHalfTimeTCI泵：计算值和实际值准吗？TCIsystem:predictsbloodandeffectsitecalculatedconcentrations,similartothew

6、aythatend-tidalmonitormeasuresgasexhaledfromthepatient.PropofolEC50(Lossofconsciousness)EC50(EC05–EC95)CpEuropean5.2(3.1-7.3)(µg/ml)Chinese3.83(2.86-4.80)CeEuropean2.8(1.5-4.1)(µg/ml)Chinese2.23(1.29-3.18)BISEuropean70.9(88.8-52.9)Chinese57.9(11.28)AEPIEuropean54.3(68.6-4

7、0.0)KennyGNC.BJA2003;90(2):127XUZhi-pengetal.INTERNATIONALJOURNALOFANESTHESIOLOGYANDRESUSCITATION2006Vol.27No.3P.144-148EC50~EC95ofRemifentanilforTetanicStimuli-----China2004EC05EC50EC95Cp（ng/ml）2.22（2.00-2.42）4.09（3.99-4.20）5.96（5.79-6.16）Ce（ng/ml））1.53（1.44-1.61）3.33（3.

8、29-3.38）5.89（5.78-6.00）BIS81.9(81.15-82.77)65.5(65.05-65.90)49.0(48.19-49.78)EC50~EC95ofSufentan