丙泊酚及靶控输注系统.ppt

TCI and Propofol(丙泊酚及靶控输注系统) Conflict of Interest(利益冲突) I’ve consulted for propofol(我为丙泊酚做过顾问) AstraZeneca I’ve consulted for remifentanil(我为瑞芬太尼做顾问) Glaxo, Abbott I’ve consulted for companies interested in TCI(我为对靶控输注系统感兴趣的公司顾问) Alaris, B Braun, Medex Pharmacokinetic Concepts(药代动力学概念) Volume of Distribution(分布容积) Clearance(清除率) Half-Life(半衰期) The time required for drug concentrations to decrease by 50%.(药物浓度降低50％所需的时间) 三室模型 Opioid Half-Lives (minutes)(鴉片類製劑的半衰期 --分钟) Opioid Pharmacokinetics(鴉片類製劑药代动力学) Context-Sensitive Half-Time(时效相关半衰期) Propofol Pharmacokinetics(丙泊酚 药代动力学) Propofol/opioid vs. isoflurane/opioid(丙泊酚/鴉片類製劑 vs.异氟醚/鴉片類製劑) 丙泊酚 药代动力学 Target Controlled Infusion靶控输注系统 TCI Solves the Differential Equations for Drug Concentration (靶控输注系统解决了药物浓度的微分方程) First Generation TCI(第一代靶控输注系统)Target = Plasma(以血浆为靶部位) CATIA: 第一靶控输注系统 (Schwilden et al, Bonn) TCI Variability(靶控输注系统的变异性) Biological variability exists(生物变异性的存在) TCI devices cannot increase biological variability(靶控输注系统不增加生物变异性) TCI Can Reduce Variability(靶控输注系统能减少变异性) TCI removes time as a confounding variable between the device setting and the patient response(靶控输注系统去除了时间这一存在于设备设置和病人反应之间的混杂变量) TCI can incorporate patient covariates to individualize drug dosing(靶控输注系统可以结合个体因素，实施个体化给药): Weight, height, gender, ethnicity (体重, 身高， 性别, 种族) Diseases (疾病) Drug interactions (药物之间相互作用) Pharmacogenetics (药物基因组学) Second Generation TCI(第二代 靶控输注系统)Target = Effect Site(效应部位为靶部位) Three compartment model with effect site(三室模型与效应部位) Fentanyl TCI, Plasma Target(芬太尼TCI，血浆靶浓度) Fentanyl TCI, Effect Site Target(芬太尼TCI，效应部位靶浓度) Propofol TCI, Plasma Target(丙泊酚TCI，血浆靶浓度) Propofol TCI, Effect Site Target(丙泊酚TCI，效应部位靶浓度) Are Drug Models Predictiveof Drug Effect?(药物模型能预测药物效应吗?) Are drug models predictive?(药物模型有预测性吗?) Mathematical models of drug behavior incorporating effect site concentrations and drug interactions predict anesthetic drug effect (e.g., loss of response to stimulation) a