中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2011年
8期
919-921
,共3页
徐凯智%李宇虹%杨莉%靳彦涛%许艳荣%边忠平%邢彦杰
徐凱智%李宇虹%楊莉%靳彥濤%許豔榮%邊忠平%邢彥傑
서개지%리우홍%양리%근언도%허염영%변충평%형언걸
舒芬太尼%冠状动脉旁路移植术,非体外循环%心脏瓣膜假体植入%药代动力学
舒芬太尼%冠狀動脈徬路移植術,非體外循環%心髒瓣膜假體植入%藥代動力學
서분태니%관상동맥방로이식술,비체외순배%심장판막가체식입%약대동역학
Sufentanil%Coronary artery bypass,off-pump%Heart valve prosthesis%Phannacokinetics
目的 研究舒芬太尼用于不同心脏手术患者的药代动力学特征.方法 择期心脏手术患者16例,年龄56～64岁,体重52 ～ 78 kg,ASA分级Ⅱ或Ⅲ级,按手术类型分为非CPB下冠状动脉旁路移植术组(Ⅰ组)和心脏瓣膜置换术组(Ⅱ组),每组8例.麻醉诱导时前臂静脉注射舒芬太尼5μg/kg,于注药后1、3、5、10、20、30、60、120、180、240和360 min时采集桡动脉血样3ml,抗凝,用液相色谱-质谱法测定血浆舒芬太尼浓度,3P97药理学程序计算CPB前和CPB时的药代动力学参数.结果 舒芬太尼在心脏手术患者的药代动力学符合三室模型,其三指数函数方程Ⅰ组为:Cp(t)＝11.7e -0.47t+1.9 e-0.043t+ 0.27 e-0.0032t；Ⅱ组CPB前和CPB时分别为:Cp(t) ＝33.4 e-1.87t+7.1 e-0.103t+2.0e 0.0248t和Cp(t) ＝23.8 e-0.54t+5.2 e-0.054t+0.15 e-0.0017t.与Ⅰ组比较,Ⅱ组CPB前常数和速率常数(P、A、B、π、α、β、K21、K13、K31、K10)、消除半衰期、药物浓度-时间曲线下面积升高,快速分布半衰期、表观分布容积降低,CPB时P、A、β、消除半衰期、k21、K10和药物浓度-时间曲线下面积升高,B、β、k31、表观分布容积和清除率降低(P< 0.05或0.01).结论 舒芬太尼在心脏手术患者的药代动力学特征符合三室模型,心功能差和低温CPB导致药物代谢减慢,作用时间延长.
目的 研究舒芬太尼用于不同心髒手術患者的藥代動力學特徵.方法 擇期心髒手術患者16例,年齡56～64歲,體重52 ～ 78 kg,ASA分級Ⅱ或Ⅲ級,按手術類型分為非CPB下冠狀動脈徬路移植術組(Ⅰ組)和心髒瓣膜置換術組(Ⅱ組),每組8例.痳醉誘導時前臂靜脈註射舒芬太尼5μg/kg,于註藥後1、3、5、10、20、30、60、120、180、240和360 min時採集橈動脈血樣3ml,抗凝,用液相色譜-質譜法測定血漿舒芬太尼濃度,3P97藥理學程序計算CPB前和CPB時的藥代動力學參數.結果 舒芬太尼在心髒手術患者的藥代動力學符閤三室模型,其三指數函數方程Ⅰ組為:Cp(t)＝11.7e -0.47t+1.9 e-0.043t+ 0.27 e-0.0032t；Ⅱ組CPB前和CPB時分彆為:Cp(t) ＝33.4 e-1.87t+7.1 e-0.103t+2.0e 0.0248t和Cp(t) ＝23.8 e-0.54t+5.2 e-0.054t+0.15 e-0.0017t.與Ⅰ組比較,Ⅱ組CPB前常數和速率常數(P、A、B、π、α、β、K21、K13、K31、K10)、消除半衰期、藥物濃度-時間麯線下麵積升高,快速分佈半衰期、錶觀分佈容積降低,CPB時P、A、β、消除半衰期、k21、K10和藥物濃度-時間麯線下麵積升高,B、β、k31、錶觀分佈容積和清除率降低(P< 0.05或0.01).結論 舒芬太尼在心髒手術患者的藥代動力學特徵符閤三室模型,心功能差和低溫CPB導緻藥物代謝減慢,作用時間延長.
목적 연구서분태니용우불동심장수술환자적약대동역학특정.방법 택기심장수술환자16례,년령56～64세,체중52 ～ 78 kg,ASA분급Ⅱ혹Ⅲ급,안수술류형분위비CPB하관상동맥방로이식술조(Ⅰ조)화심장판막치환술조(Ⅱ조),매조8례.마취유도시전비정맥주사서분태니5μg/kg,우주약후1、3、5、10、20、30、60、120、180、240화360 min시채집뇨동맥혈양3ml,항응,용액상색보-질보법측정혈장서분태니농도,3P97약이학정서계산CPB전화CPB시적약대동역학삼수.결과 서분태니재심장수술환자적약대동역학부합삼실모형,기삼지수함수방정Ⅰ조위:Cp(t)＝11.7e -0.47t+1.9 e-0.043t+ 0.27 e-0.0032t；Ⅱ조CPB전화CPB시분별위:Cp(t) ＝33.4 e-1.87t+7.1 e-0.103t+2.0e 0.0248t화Cp(t) ＝23.8 e-0.54t+5.2 e-0.054t+0.15 e-0.0017t.여Ⅰ조비교,Ⅱ조CPB전상수화속솔상수(P、A、B、π、α、β、K21、K13、K31、K10)、소제반쇠기、약물농도-시간곡선하면적승고,쾌속분포반쇠기、표관분포용적강저,CPB시P、A、β、소제반쇠기、k21、K10화약물농도-시간곡선하면적승고,B、β、k31、표관분포용적화청제솔강저(P< 0.05혹0.01).결론 서분태니재심장수술환자적약대동역학특정부합삼실모형,심공능차화저온CPB도치약물대사감만,작용시간연장.
Objective To study the pharmacokinetics of sufentanil in patients undergoing different cardiac surgeries with or without CPB.Methods Sixteen ASA Ⅱ or Ⅲ patients aged 56-64 yr weighing 52-78 kg undergoing cardiac surgery were divided into 2 groups ( n ＝ 8 each):group Ⅰ off-pump coronary artery bypass grafting and group Ⅱ valve replacement.Radial artery and peripheral vein were cannnlated.A bolus of sufentanil 5μg/kg was administered iv after induction of anesthesia.Blood samples were obtained from radial artery at 1,3,5,10,20,30,60,120,180,240,360 min after sufentanil injection.Plasma was immediately separated and stored at - 80 C for determination of plasma sufentanil concentration by liquid c hromatography-mass spectrometry.Pharmacokinetic parameters were calculated by 3P97 pharmacological program.Results The pharmacokinetic profile of sufentanil was best described by a three-compartment open model.The 3 exponential equations in group Ⅰ,before and during CPB in group Ⅱ were:Cp(t) ＝ 11.7 e-0.47t + 1.9 e0.043t + 0.27 e-0.0032t ; Cp(t) ＝ 33.4 e-1.87t + 7.1e-0.103t +2.0 e-0.0248t and Cp(t) ＝ 23.8 e-0.54t + 5.2 e0.054t + 0.15 e-0.0017t respectively.There was significant difference in most of the pharmacokinetic parameters between the 2 groups.Conclusions The pharmacokinetics of sufentanil in patients undergoing different cardiac surgeries can be described by ~compartment open model.Low cardiac function and CPB can reduce its drug metabolism rate and prolong the duration of action.
