丙泊酚注射综合征

Title: Propofol Infusion Syndrome (PRIS)

题目：丙泊酚注射综合征

Author 作者: Haney Mallemat

Propofol is generally a well-tolerated sedative / amnestic but occasionally it can lead to the propofol infusion syndrome (PRIS); a metabolic disorder causing end-organ dysfunction.

通常情况下，病人对丙泊酚在镇静和帮助遗忘方面耐受很好，但偶尔会造成所谓的丙泊酚注射综合征（PRIS），既可导致器官功能衰竭的代谢紊乱。

Suspect PRIS in patients with increasing lactate levels, worsening metabolic acidosis, worsening renal function, increased triglyceride levels, or creatinine kinase levels. End-organ effects include:

如病人出现乳酸血症，代谢性酸中毒，肾功能恶化，甘油三酯水平增高，或肌酸激酶水平增高。器官损伤包括：

• Myocardial dysfunction / Arrhythmias

• 心功能失调／心律失常

• Rhabdomyolysis

• 横纹肌溶解症

• Acute renal failure

• 急性肾功能衰竭

The true incidence of PRIS is unknown, however, certain risk factors have been identified:

虽然PRIS的确切发生率还不清楚，但其危险因素有：

• Doses >4-5mg/kg/hour

• 剂量超过4－5mg／kg／h

• <18 years of age

• 年龄在18岁以下

• Critically-ill patients; especially receiving vasopressors or steroids

• 危重病人；尤其是在用升压药或激素时

• History of mitochondrial disorders

• 线粒体功能紊乱病史

• Infusions >48 hours

• 注射时间超过48h

Prevent PRIS by using adequate analgesia (with morphine or fentanyl) post-intubation, which may reduce the overall dosage of propofol ultimately reducing the risk.

气管插管后用足量的止痛药（如吗啡或芬太尼）可减少丙泊酚的剂量，进而防止产生PRIS的危险，

If PRIS develops, stop propofol and provide supportive care; IV fluids, ensuring good urine output, adequate oxygenation, dialysis (if indicated), vasopressor and inotropic support.

如发生PRIS，停止丙泊酚并加强支持疗法，包括静脉输液，保证足够的尿量，给氧，透析（如需要），升压药和强心药。