Long-term Continuous Infusion of Propofol as a Means of Sedation for Patients in Intensive Care Unit: Relationship between Dosage and Serum Concentration

加護病房患者長期使用連續性靜脈注射Propofol所需劑量和血中濃度

王淑惠(Shu-Hui Wang) ； 許光陽(Kuang-Yang Hsu) ； 汪佑襄(Yow-Shieng Uang)

《Acta Anaesthesiologica Sinica》 36卷2期 (1998/06) Pp. 93-98

摘要

Background: We studied the effect of long-term continuous propofol infusion in patients who were utilizing mechanical ventilation in intensive care unit. The purpose of our study was to identify the appropriate dosage of propofol and to monitor the relating serum level that would provide satisfactory sedative and hypnotic effects to the patients, i.e., to procure a Ramsay Sedation Scale (RSS) value between 2 and 3. Methods: Ten mechanically ventilated lCU patients were studied. The syringe pump was set to deliver propofol at a rate of 1 mg/kg/h without an initial loading dose. After continuous infusion of propofol for 24 h, in each patient 5 mI of whole blood was sampled daily for one week. All samples were analyzed for serum level of propofol by high performance liquid chromatography. Results: When the Ramsay Sedation Scale (RSS) value was between 2 and 3, the mean dosage of infused propofol was 0.71 ± 0.31 mg/kg/h (ranging from 0.58 to 1.27 mg/kg/h) and the mean plasma concentration was 0.58 ± 0.22 μg/ml (ranging from 0.20 to 0.86 μg/ml). The lipid serum level was measured in three patients whose infusion duration was greater than 14 days. The respective level was 321 mg/dl, 139 mg/dl, and 99 mg/dl. The first patient died from multiple organ failure as a result of multiple trauma. Four patients simultaneously received infusion of propofol and muscle relaxant. Conclusions: We concluded that propofol infusion given at a rate of 0.71 ± 0.31 mg/kg/h and a plasma concentration level of less than 1 μg/ml would be sufficient to produce a sedation with RSS value between 2 and 3.

關鍵字

Sedatives, nonbarbiturate: propofol ； Intermittent Positive-pressure Ventilation ； Monitoring: Ramsay Sedation Scale (RSS)

並列摘要

背景：確認加護病房使用呼吸器患者長期連續性靜脈注射propofol，達到滿意的鎮靜和安眠效果時，所需要的使用劑量和患者血中濃度。方法：以前瞻性的研究方法篩選十位加護病房使用呼吸器的患者，所有患者均符合鎮靜適應症，每位患者以唧筒控制每小時propofol之注入量，初始劑量以每小時每公斤1毫克且不投予負荷劑量，連續靜脈注射24小時後，患者於往後一週每天抽取患者5 ml全血一次，並以高液相色層分析法監測其血中濃度。結果：當患者Ramsay Sedation Score指數在2－3分時，使用propofol平均劑量為0.71 ± 0.31 mg/kg/h（範圍0.58至1.27 mg/kg/h），平均血中濃度是0.58 ± 0.22μg/ml（範圍0.2至0.86μg/ml）。其中三位患者連續靜脈注射十四天以上，監測得血中三甘脂肪酸濃度分別是321 mg/dL, 139 mg/dL及99mg/dL。十位病例中僅一例因多處嚴重創傷併多重器官衰竭死亡，有四例合併使用連續性靜脈注射肌肉鬆弛劑。結論：加護病房使用呼吸器患者連續靜脈注射propofol 0.58至1.27 mg/kg/h時，血中濃度維持在1 μg/ml以下，即可達鎮靜安眠指數2－3之效果。

並列關鍵字

鎮靜劑，非巴比妥鹽：Propofol ； 間歇性正壓呼吸治療 ； 監測：Rasmay鎮靜安眠指數