CAJ | 학술논문

目的研究肝硬化患者复合瑞芬太尼时异丙酚的药代动力学.方法拟在内镜下行食道静脉曲张套扎术的肝硬化患者10例(试验组);拟行胃镜检查术患者10例(对照组),肝功能未见异常,男女各半,年龄18～55岁,体重40～75 kg.静脉注射异丙酚1.5 mg/kg和瑞芬太尼0.5 μg/kg,5 min后再次静脉注射异丙酚0.5 mg/kg和瑞芬太尼0.2 μg/kg.分别于给药前、给药后2、5、10、15、20、30、45、60、80、120 min时采集桡动脉血样,采用气相色谱质谱联用法测定血浆异丙酚浓度,采用DAS 2.0软件计算药代动力学有关指标.结果异丙酚的血药浓度.时间曲线符合开放性三室模型;与对照组比较,试验组分布半衰期、消除半衰期、终末半衰期、血药浓度-时间曲线下面积和转运速率常数差异无统计学意义(P＞0.05),表观分布容积和清除率升高(P＜0.01).结论肝硬化患者复合瑞芬太尼麻醉时,异丙酚的表观分布容积和清除率升高,而其他药代动力学参数无明显变化.
목적 연구간경화환자복합서분태니시이병분적약대동역학.방법의재내경하행식도정맥곡장투찰술적간경화환자10례(시험조);의행위경검사술환자10례(대조조),간공능미견이상,남녀각반,년령18～55세,체중40～75 kg.정맥주사이병분1.5 mg/kg화서분태니0.5 μg/kg,5 min후재차정맥주사이병분0.5 mg/kg화서분태니0.2 μg/kg.분별우급약전、급약후2、5、10、15、20、30、45、60、80、120 min시채집뇨동맥혈양,채용기상색보질보련용법측정혈장이병분농도,채용DAS 2.0연건계산약대동역학유관지표.결과 이병분적혈약농도.시간곡선부합개방성삼실모형;여대조조비교,시험조분포반쇠기、소제반쇠기、종말반쇠기、혈약농도-시간곡선하면적화전운속솔상수차이무통계학의의(P＞0.05),표관분포용적화청제솔승고(P＜0.01).결론 간경화환자복합서분태니마취시,이병분적표관분포용적화청제솔승고,이기타약대동역학삼수무명현변화.
Objective To investigate the pharmacokinetics of propofol when combined with remifentanil in patients with liver cirrhosis.Methods Ten patients (5 males, 5 females) with liver cirrhosis scheduled for endoscopic esophageal varix ligation (test group) and 10 cases (5 males, 5 females) with normal liver function scheduled for gastroscopy (control group), aged 18-55 yr, weighing 40-75 kg, were studied. The patients were unpremedicated. All the patients received iv injection of propofol 1.5 mg/kg and remifentanil 0.5 μg/kg, and 5 min later propofol 0.5 mg/kg and remifentanil 0.2 μg/kg was given again. Blood samples were taken from radial artery before administration and at 2, 5, 10, 15, 20, 30, 45, 60, 80 and 120 min after administration for determination of the plasma propofol concentration using gas chromatography-mass spectrography. The pharmacokinetic parameters were calculated using DAS 2.0 software.Results The pharmacokinetics of propofol was best described by a three-compartment open model. There was no significant difference in the distribution half-life, elimination halflife , terminal half-life, area under the curve and transfer rate constant between the two groups ( P ＞ 0.05) . The apparent volume of distribution of propofol and clearance were significantly increased in test group compared with control group (P ＜0.01) .Conclusion When propofol combined with remifentanil is used in patients with liver cirrhosis, the apparent volume of distribution of propofol and clearance are significantly increased, while no changes in the other pharmacokinetic parameters are found.