中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2009年
7期
617-620
,共4页
马民玉%王艳萍%冉菊红%阚全程
馬民玉%王豔萍%冉菊紅%闞全程
마민옥%왕염평%염국홍%감전정
年龄因素%布比卡因%药代动力学%麻醉,硬膜外
年齡因素%佈比卡因%藥代動力學%痳醉,硬膜外
년령인소%포비잡인%약대동역학%마취,경막외
Age factors%Bupivacaine%Pharmacokinetics%Anesthesia,epidural
目的 探讨年龄因素对患者硬膜外注射左旋布比卡因药效学和药代动力学的影响.方法 择期拟行下肢手术患者45例,年龄30～72岁,体重52～83 ks,ASA Ⅰ或Ⅱ级,按不同年龄分为3组:Ⅰ组(≤45岁)、Ⅱ组(46～64岁)和Ⅲ组(>64岁),每组15例,均采用腰段硬膜外麻醉,左旋布比卡因(7.5 mg/ml)用量1.8 mg/kg(含肾上腺素5 μg/ml).经L1,2硬膜外穿刺成功后,注射试验量0.5%左旋布比卡因3 ml,3 min后注射剩余量0.75%左旋布比卡因.硬膜外注药后记录感觉和运动阻滞效果及不良反应的发生情况;每组随机选择9例,于注药后即刻、注药后10、20、30、45、60、90、120、180、240、360、480、840、和1 440 min时采用高效液相色谱法测定血浆左旋布比卡因浓度,绘制血浆左旋布比卡因浓度-时间曲线,计算3组药代动力学参数.结果 与Ⅰ组比较,Ⅲ组最高感觉阻滞平面高,感觉和运动阻滞维持时间长,(P<0.05);各组麻醉效果优良率均达100%;各组左旋布比卡因的血浆药物浓度-时间曲线均符合二房室开放模型;硬膜外注药后1 440 min时Ⅱ组和Ⅲ组左旋布比卡因血药浓度高于Ⅰ组(P<0.05);Ⅱ组和Ⅲ组左旋布比卡因消除半衰期明显长于Ⅰ组,Ⅲ组明显长于Ⅱ组(P<0.05).结论 不同年龄患者硬膜外注射0.75%左旋布比卡因1.8 mg/kg安全有效;随年龄增加,感觉阻滞平面升高、感觉和运动阻滞恢复时间延长,药物代谢明显减慢.
目的 探討年齡因素對患者硬膜外註射左鏇佈比卡因藥效學和藥代動力學的影響.方法 擇期擬行下肢手術患者45例,年齡30～72歲,體重52～83 ks,ASA Ⅰ或Ⅱ級,按不同年齡分為3組:Ⅰ組(≤45歲)、Ⅱ組(46～64歲)和Ⅲ組(>64歲),每組15例,均採用腰段硬膜外痳醉,左鏇佈比卡因(7.5 mg/ml)用量1.8 mg/kg(含腎上腺素5 μg/ml).經L1,2硬膜外穿刺成功後,註射試驗量0.5%左鏇佈比卡因3 ml,3 min後註射剩餘量0.75%左鏇佈比卡因.硬膜外註藥後記錄感覺和運動阻滯效果及不良反應的髮生情況;每組隨機選擇9例,于註藥後即刻、註藥後10、20、30、45、60、90、120、180、240、360、480、840、和1 440 min時採用高效液相色譜法測定血漿左鏇佈比卡因濃度,繪製血漿左鏇佈比卡因濃度-時間麯線,計算3組藥代動力學參數.結果 與Ⅰ組比較,Ⅲ組最高感覺阻滯平麵高,感覺和運動阻滯維持時間長,(P<0.05);各組痳醉效果優良率均達100%;各組左鏇佈比卡因的血漿藥物濃度-時間麯線均符閤二房室開放模型;硬膜外註藥後1 440 min時Ⅱ組和Ⅲ組左鏇佈比卡因血藥濃度高于Ⅰ組(P<0.05);Ⅱ組和Ⅲ組左鏇佈比卡因消除半衰期明顯長于Ⅰ組,Ⅲ組明顯長于Ⅱ組(P<0.05).結論 不同年齡患者硬膜外註射0.75%左鏇佈比卡因1.8 mg/kg安全有效;隨年齡增加,感覺阻滯平麵升高、感覺和運動阻滯恢複時間延長,藥物代謝明顯減慢.
목적 탐토년령인소대환자경막외주사좌선포비잡인약효학화약대동역학적영향.방법 택기의행하지수술환자45례,년령30～72세,체중52～83 ks,ASA Ⅰ혹Ⅱ급,안불동년령분위3조:Ⅰ조(≤45세)、Ⅱ조(46～64세)화Ⅲ조(>64세),매조15례,균채용요단경막외마취,좌선포비잡인(7.5 mg/ml)용량1.8 mg/kg(함신상선소5 μg/ml).경L1,2경막외천자성공후,주사시험량0.5%좌선포비잡인3 ml,3 min후주사잉여량0.75%좌선포비잡인.경막외주약후기록감각화운동조체효과급불량반응적발생정황;매조수궤선택9례,우주약후즉각、주약후10、20、30、45、60、90、120、180、240、360、480、840、화1 440 min시채용고효액상색보법측정혈장좌선포비잡인농도,회제혈장좌선포비잡인농도-시간곡선,계산3조약대동역학삼수.결과 여Ⅰ조비교,Ⅲ조최고감각조체평면고,감각화운동조체유지시간장,(P<0.05);각조마취효과우량솔균체100%;각조좌선포비잡인적혈장약물농도-시간곡선균부합이방실개방모형;경막외주약후1 440 min시Ⅱ조화Ⅲ조좌선포비잡인혈약농도고우Ⅰ조(P<0.05);Ⅱ조화Ⅲ조좌선포비잡인소제반쇠기명현장우Ⅰ조,Ⅲ조명현장우Ⅱ조(P<0.05).결론 불동년령환자경막외주사0.75%좌선포비잡인1.8 mg/kg안전유효;수년령증가,감각조체평면승고、감각화운동조체회복시간연장,약물대사명현감만.
Objective To investigate the effects of age on the pharmacokineties and pharmacodynamics of levobupivacaine after epidural administrstion.Methods Forty-five ASA Ⅰ or Ⅱ patients of both sexes (26 male, 19 female) aged 30-72 yr, weighing 52-83 kg scheduled for elective lower extremity surgery under epidural anesthesia, were divided into 3 age groups ( n = 15 each) : group Ⅰ≤45 yr; group Ⅱ 46-64 yr and group Ⅲ > 64 yr. Epidural anesthesia was performed at the L1,2 interspace. All of the patients received levobupivacaine 1.8 mg/kg with epinephrine 5 μg/ml given epidurally over 1.5 min. Assessment of sensory block (onset time, peak effect time, upper spread of sensory block, duration of anesthesia) and degree of motor block (using modified Bromage scale) were made. Blood samples were taken from central vein at 0, 10, 20, 30, 45, 60 90, 120, 240, 360, 480, 840 and 1 440 min after epidural administration for determination of plasma concentration of levobupivacaine by high-performance liquid chromatography (HPLG) in nine patients in each group. The pharmacokinetic parameters were calculated from plasma concentration-time data with 3P97 software package. Results The cephalad spread of sensory block was significantly higher in group Ⅲ than in group Ⅰ . The duration of sensory and motor block was significantly longer in group Ⅲ than in group Ⅰ . The plasma concentration-time curves of levobupivacaine were fitted to a two-compartment open model in the 3 groups. The plasma concentrations of levobupivacaine were significantly higher at 1 440 min after epidural administration in group Ⅲ and Ⅱ than in group Ⅰ. The t1/2β was significantly different among the 3 groups. Conclusion 0.75% levobupivacaine is safe and effective for epidural anesthesia. Age affects the pharmacokinetics (t1/2β in particular) and pharmacodynamics of levobupivacaine administered epidurally.
