体外循环中诸多因素对异丙酚血药浓度影响的分析-analysis of the influence of many factors on propofol blood concentration during cardiopulmonary bypass.docx

新疆医科大学医学博士学位论文 新疆医科大学医学博士学位论文 — — PAGE 4— — — PAGE 13— Analysis and Investigation of Influencing Factors of Cardiopulmonary Bypass on Propofol Concentration Abstract Background: Cardiopulmonary bypass is one of the necessary technologies for open heart surgery. But many factors including hemodilution, temperature, sorts of oxygenator, all kinds of drugs in priming fluid and ultrafiltration could affect the plasma concentration of propofol. The author would investigate these influencing factors from in vitro and in vivo to supply proper remedy for clinical anesthesia. Objective: 1) To investigate the effect of AHHD and ANHD on the propofol concentration and to evaluate the performance of target controlled infusion (TCI) for propofol; 2) To investigate the influence of oxygenator, temperature, drug and CPB time on propofol concentration; 3) To investigate the effect of domestic extracorporeal circuit on plasma concentration of propofol during target controlled infusion and to evaluate the performance of target controlled infusion (TCI) for propofol; 4) To investigate the effect of CPB on the propofol concentration and to assess both clinical effects and inflammatory mediator removal by high-volume, zero-fluid balance ultrafiltration (Z-BUF) during CPB. Methods: 1) Fifty four patients, ASA Ⅰ-Ⅱ, scheduled for operations were randomly divided into three groups. In AHHD group (n=18), Lactated Ringers solution (RL) 10 ml·kg-1 was infused over 60min before induction of anesthesia. 10min after TCI propofol was started, AHHD was performed by 6% HES (hydroxyethylstarch 200/0.5) 20ml·kg-1. In ANHD group (n=18), autologous blood was removed from arterial line and stored in units of about 500mL with CPDA-l-stabilizer until the hematocrit (Hct) fell to 26%. Simultaneously, an equal amount of RL and 6% HES was given via a peripheral venous line. The process of ANHD lasted for 30min. After 10min of stabilization of ANHD, TCI propofol was started. In the control group, pati