得普利麻靶控輸注技術(shù)－Diprifusor/TCITCI的定義TCI是一種輸注系統(tǒng)，容許麻醉醫(yī)生按不同需要選擇所要求的靶血藥濃度…通過調(diào)整靶濃度來控制麻醉的深淺

TCI不是完全的計(jì)算機(jī)控制麻醉為什么使用TCI基本出發(fā)點(diǎn)使靜脈麻醉深淺的調(diào)節(jié)能像吸入麻醉利用標(biāo)準(zhǔn)揮發(fā)罐調(diào)節(jié)那樣簡單TCI的優(yōu)點(diǎn)－實(shí)踐方面使用方便操作簡單能持續(xù)顯示所計(jì)算的血藥濃度對中斷輸注有補(bǔ)償作用避免了對輸注速率的復(fù)雜計(jì)算TCI的優(yōu)點(diǎn)－理論方面麻醉的控制麻醉深度的良好控制改善了對循環(huán)，呼吸功能的影響

誘導(dǎo)期的反應(yīng)可作為預(yù)設(shè)麻醉維持的參考，比手控更精確什么是“Diprifusor

”TCI得普利麻的靶控輸注系統(tǒng)全球第一個(gè)商業(yè)化的TCI系統(tǒng)使得普利麻靜脈麻醉更方便更可控使靜脈麻醉像使用“揮發(fā)罐”一樣方便與著名輸注泵廠商合作開發(fā)Diprifusor/TCI都包括什么?藥物得普利麻預(yù)充注射器(Pre-Filled

Syringe)帶有識別標(biāo)記輸注系統(tǒng)Diprifusor軟件內(nèi)裝有Diprifusor軟件的輸注泵有關(guān)資料阿斯利康公司提供的得普利麻的處方資料泵生產(chǎn)廠家提供的詳細(xì)的輸注泵使用說明得普利麻預(yù)充注射器(PFS)專用于內(nèi)裝置Diprifusor的TCI輸注泵亦可用于普通輸注泵可用作普通注射器得普利麻預(yù)充注射器(PFS)每支藥物只用于一個(gè)病人不可重復(fù)使用保持得普利麻及輸注設(shè)備無菌剩余的藥物必須丟棄PFS的識別標(biāo)記藥物識別與安全使用

‘Diprifusor’TCI只能使用標(biāo)記的PFS，不能使用其它藥物

核對注射器內(nèi)‘Diprivan’的濃度(藍(lán)=1%，紅=2%)才可按要求正確輸注

當(dāng)一支PFS用完后，為避免重復(fù)使用，標(biāo)記自動(dòng)清除*?

University

of

G

lasgow‘Diprifusor’TCI軟件安裝于“Diprifusor”TCI亞系統(tǒng)內(nèi)三室藥代模型及得普利麻(丙泊酚)的藥代動(dòng)力學(xué)參數(shù)兩套獨(dú)立的運(yùn)算系統(tǒng)，維持正常輸注，保證病人安全*

Contact

manufacturer

for

details

and

av

ailability裝載Diprifusor的輸注泵商業(yè)化的輸注系統(tǒng)Graseby

3500ALARIS

IVAC

TIVA

TCIVial

Médical

Master

TCIGraseby

3500泵ALARIS

IVAC

TIVA

TCI泵輸入得普利麻的總量微調(diào)信息鍵(效應(yīng)部位濃度、達(dá)到靶濃度的時(shí)間)微調(diào)TC

I模式提示TC

I模式提示靶血藥濃度計(jì)算的血藥濃度液晶顯示Consult

Instruction

Manual

for

details

of

display

and

operationGraseby

3500的面板設(shè)置Consult

Direc

tions

for

Use

for

details

of

display

and

operation調(diào)節(jié)鍵計(jì)算濃度的趨勢圖效應(yīng)部位濃度得普利麻輸注量泵工作狀態(tài)計(jì)算的血藥濃度靶血藥濃度預(yù)計(jì)的清醒時(shí)間ALARIS

IVAC

TIVA

TCI的面板顯示0501200051

01

5時(shí)間(m

inut

es)2

02

53

03

56802輸注速率(m

l/h1)0

0血藥濃4

度(μ

g/m

l)計(jì)算的血藥濃度(泵自動(dòng)計(jì)算并顯示〕靶血藥濃度

麻醉醫(yī)生設(shè)置43215Consult

pump

manufacturer

for

detailed

s

pec

ific

ation商業(yè)化的TCI泵的一般特征輸入病人詳細(xì)資料a

geb

o

d

y

w

e

ig

h

t1

6

–1

0

0

y

e

a

rs3

0

–1

5

0

k

g識別‘Diprivan’的濃度(1%

or

2%)設(shè)置并調(diào)整靶濃度顯示要0.求1–的1靶5

μ濃g/ml度持續(xù)顯示計(jì)算的血藥濃度變化顯示計(jì)算的效應(yīng)部位(腦)的藥物濃度預(yù)計(jì)達(dá)到靶濃度時(shí)間及病人清醒時(shí)間顯示輸注速率和使用藥物總量TCI的意義微處理器控制輸注泵改變了按mg/kg/h計(jì)算劑量的概念麻醉醫(yī)生僅需要輸入病人的體重病人的年齡–所需的血藥濃度(靶濃度g/ml

)Consult

full,

loc

al

pr

es

cribing

information靶濃度與誘導(dǎo)時(shí)間源于‘Diprifusor’

TCI的臨床驗(yàn)證結(jié)果根據(jù)病人反應(yīng)滴定而達(dá)到所需麻醉深度成人(<55

years)–通常4

to

8

μg/ml術(shù)前用藥病人–初始靶濃度4

μg/ml無術(shù)前用藥病人–初始靶濃度6

μg/ml如下病人應(yīng)使用更低初始濃度:>

55

yearsASA

III

or

IV級通常在60

to

120秒達(dá)到誘導(dǎo)水平誘導(dǎo)期的初始靶濃度4

0

%2

5

%5

0

%7

5

%7

5

%靶血藥濃度1

0

0

%n

=

20n

=

20n

=

209

0

%3

μ

g

/

m

l4

μ

g

/

m

l5

μ

g

/

m

l成功誘導(dǎo)的百分比Chaudhr

i

S

et

al.

1992Failure

of

induction

(patients

not

induced

within

3

minutesof

achieving

the

target

concentr

ation):

tar

get

incr

eased

to

6

μg/ml‘Diprifusor’TCI的誘導(dǎo)時(shí)間‘Diprifusor’

TCIn

=

79人工控制輸注n

=

805575(SD

10.6)(SD

18.8)p

<

0.01平均誘導(dǎo)時(shí)間(seconds)2

0

4

0

6

0

8

0Russell

D

et

al.

1995The

initial

infusion

rate

was

higher

with

`Diprifusor′TCI

(1,200

ml/h)

than

with

manual

c

ontrol(600ml/h).

The

mean

dose

of

`Dipriv

an′administered

at

the

time

of

insertion

of

the

lar

yngeal

mas

kair

way

was

significantly

higher

(

p

<

0.05)

with

`Diprifusor′T

CI

(201

mg)

than

with

manual

contr

ol

(160

mg)UK的研究，ASAI

or

II級病人‘Diprifusor’TCI的誘導(dǎo)質(zhì)量Hutton

P

et

al.

1995n

=

79UK的研究，ASA

I

or

II級病人The

initial

infusion

rate

was

higher

with

`Diprifus

or

′TCI

(1,200

ml/h)

than

with

manual

control

(600

ml/h)

.

The

mean

dose

of

`Diprivan′adminis

tered

at

the

time

of

ins

ertion

of

the

laryngeal

maskair

way

was

s

ignific

antly

higher

(p

<

0.05)

with

`Dipr

ifusor′TCI

(201

mg)

than

with

manual

c

ontrol

(160

mg)優(yōu)良74.7%好22.8%優(yōu)良72.5%好22.5%病人的百分比‘Diprifusor’

TCI人工控制輸注不良2.5%不良5.0%n

=

80麻醉維持時(shí)的靶濃度病人類別平均維持麻醉的靶濃度健康成人(ASA

I

or

II)3.5

to

5.3

μg/ml心臟病人(ASA

II,III

or

IV)2.8

to

3.4

μg/ml>55

years3.5

μg/ml‘Diprifusor’TCI維持麻醉的質(zhì)量Hutton

P

et

al.

1995n

=

76UK的研究，ASA

I

or

II級病人The

initial

infusion

rate

was

higher

with

`Diprifusor′TCI

(1,200

ml/h)

than

with

manual

c

ontrol

(600

ml/h).

The

mean

dose

of

`Dipriv

an′administered

at

the

time

of

insertion

of

the

lary

ngeal

mas

kair

way

was

significantly

higher

(

p

<

0.05)

with

`Diprifusor′T

CI

(201

mg)

than

with

manual

contr

ol

(160

mg)病人百分比(主要通過觀察來估計(jì))‘Diprifusor’TCI

人工控制輸注不良

0%

不良

3

.

8%優(yōu)良77.6%好22.4%優(yōu)良68.7%好27.5%n

=

80手術(shù)切皮時(shí)病人體動(dòng)1

0

%人工控制輸注n=

80NS

p

=

0

.1

93

0

%2

8

.8

%病人的百分比2

0%1

9

.7

%‘

D

ip

r

ifus

o

r

’

T

CIn=

76Russell

D

et

al.

1995UK的研究，ASA

I

or

II級病人The

mean

overall

infusion

rate

dur

ing

maintenance

was

signific

antly

greater

(

p

=

0.001)

in

the‘Diprifus

or

’

TCI

group

(

13.2

mg/k

g/h)

than

in

the

manual

contr

ol

gr

oup

(8.2

mg/kg/h)對間斷補(bǔ)充給藥的需要5

0

%1

0

%3

–5

d

os

e

s為加深麻醉需間斷補(bǔ)充用藥的2病5人%百分比4

0

%1

–

2

do

s

e

s人工控制輸注n=

80‘D

i

p

ri

fus

or

’

T

C

In=

750

%H

u

t

t

o

n

P

et

a

l.

19

95The

mean

overall

infusion

rate

dur

ing

maintenance

was

signific

antly

greater

(

p

=

0.001)

in

the‘Diprifus

or

’

TCI

group

(

13.2

mg/k

g/h)

than

in

the

manual

contr

ol

gr

oup

(8.2

mg/kg/h).

Setting

a

higher

target

c

oncentration

with

‘Dipr

ifusor’

TCI

results

in

automatic

administration

of

a

bolusOverall

results

from