Propofol infusion syndrome
Propofol infusion syndrome
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DOI：
10.1007/s00101-004-0756-3
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发表时间：
2004-10-01
期刊：
影响因子：
--
通讯作者：
Roggenbach, J
中科院分区：
文献类型：
--
作者：
Motsch, J;Roggenbach, J
异丙酚输注综合征不仅在长期使用异丙酚镇静的患者中观察到，而且在持续5 h的异丙酚麻醉期间也观察到。据推测，病理生理学原因是丙泊酚损害脂肪酸链的氧化和抑制线粒体中的氧化磷酸化，导致乳酸酸中毒和肌肉坏死。据推测，丙泊酚可能作为触发底物在存在的启动因子。严重的疾病，其中病人已暴露于高水平的儿茶酚胺和皮质醇已被确定为触发底物。一旦怀疑发生丙泊酚输注综合征，必须立即停止丙泊酚输注，并开始特定的治疗措施，包括心循环稳定和纠正代谢性酸中毒。为了增加丙泊酚及其潜在毒性代谢产物的消除，建议进行血液透析或血液滤过。由于其可能的致命性副作用，应重新考虑在危重患者中使用丙泊酚进行长期镇静。在持续输注丙泊酚期间发生不明原因的乳酸酸中毒的情况下，必须考虑丙泊酚输注综合征。
Propofol infusion syndrome has not only been observed in patients undergoing long-term sedation with propofol, but also during propofol anesthesia lasting 5 h. It has been assumed that the pathophysiologic cause is propofol's impairment of oxidation of fatty acid chains and inhibition of oxidative phosphorylation in the mitochondria, leading to lactate acidosis and muscular necrosis. It has been postulated that propofol might act as a trigger substrate in the presence of priming factors. Severe diseases in which the patient has been exposed to high catecholamine and cortisol levels have been identified as trigger substrates. Once the development of propofol infusion syndrome is suspected, propofol infusion has to be stopped immediately and specific therapeutic measures initiated, including cardiocirculatory stabilization and correction of metabolic acidosis. To increase elimination of propofol and its potential toxic metabolites, hemodialysis or hemofiltration are recommended. Due to its possible fatal side effects, the use of propofol for long-term sedation in critically ill patients should be reconsidered. In cases of unexplained lactate acidosis occurring during continuous propofol infusion, propofol infusion syndrome must be taken into consideration.