高容量血液稀释对全髋置换术病人异丙酚药代动力学的影响  

Effect of acute hypervolemic hemodilution on pharmacokinetics of propofol in patients undergoing total hip replacement

作　　者：唐建国[1] 吴贵龙[1] 朋立超[1] 朱彪[2] 仓静[2] 缪长虹[2] 薛张纲[2] 

机构地区：[1]复旦大学附属上海市第五人民医院麻醉科,200240 [2]复旦大学附属中山医院麻醉科

出　　处：《中华麻醉学杂志》2006年第1期22-25,共4页Chinese Journal of Anesthesiology

基　　金：上海市卫生局科技发展基金(034057)

摘　　要：目的观察高容量血液稀释(HHD)对全髋置换术病人异丙酚药代动力学的影响。方法择期行全髋置换术病人16例,ASAⅠ或Ⅱ级,年龄20～55岁,随机分为2组(n=8)：常规补液组(C 组)和 HHD 组(H 组),入室后均输入乳酸林格氏液(术前禁食量,h 为术前禁食时间)0.7ml·kg^(-1)·h^(-1) 后,C 组按常规补液方案补充手术需要量；H 组以20ml·kg^(-1)·h^(-1)速率输入4%琥珀酰明胶20ml·kg^(-1) 实施 HHD,目标红细胞压积30%。静脉注射咪唑安定0.04mg·kg^(-1)、芬太尼4μg·kg^(-1)、异丙酚1.5 mg·kg^(-1)及琥珀胆碱2mg·kg^(-1)麻醉诱导后气管内插管,分别于注射异丙酚后1、2、4、6、10、15、30、45、 60、75、90、120、150、180、240、300、360min 经颈内静脉采血,用反向高效液相色谱荧光法测定血浆异丙酚浓度,用3P97药代动力学软件进行药代学数据分析。结果与 C 组比较,H 组注射异丙酚后1～10 min 异丙酚血药浓度降低(P＜0.01),注射异丙酚后15～360min 异丙酚血药浓度差异无统计学意义。异丙酚药代动力学特征符合药代动力学三室开放模型,与 C 组比较,H 组中央室分布容积增加,消除相半衰期延长,K_(10)和全身清除率降低(P＜0.01或0.05),快速分布相半衰期、慢分布相半衰期、K_(12)、 K_(21)、K_(13)、K_(31)、曲线下面积差异无统计学意义。结论 HHD 提高了异丙酚的中央室分布容积,降低了 K_(10)和全身清除率,延长了消除相半衰期,可能导致药效增强。Objective To investigate the influence of acute hypervolemic hemodilution （HHD） on pharmacokinetics of propofol. Methods Sixteen ASA Ⅰ or Ⅰ patients aged 20-55 yrs undergoing elective surgery under general anesthesia combined with epidural analgesia were randomly allocated into 2 groups （ n = 8 each） ; Ⅰ control group and Ⅱ HHD group. The patients were premeditated with intramuscular phenobarbital 0.1 g and scopolamine 0.3 mg. Right internal jugular vein was cannulated for CVP monitoring and blood sampling. Radial artery was cannulated for BP monitoring. All patients in both groups received lactated Ringer＇s solution （0.7 ml · kg^-1 × number of hours of fasting before operation） before induction of general anesthesia. In HHD group 4% gelofusine 20 ml· kg^- 1 was infused at the rate of 20 ml· kg^-1· h^-1 . Anesthesia was induced with midazolam 0.04 mg· kg^- 1 , fentunyl 4 μg· kg^- 1 and propofol 1.5 mg· kg^-1. Tracheal intubation was facilitated by succinylcholine 2 mg·kg^-1. Anesthesia was maintained with isoflurane, fentanyl, vecuronium and epidural analgesia. ECG, BP, SpO2, PETCO2 and CVP were continuously monitored. Blood samples were taken at 1, 2, 4, 6, 10, 15, 30, 45, 60, 75, 90, 120, 150, 180, 240, 300 and 360 min after propofol was given IV for determination of plasma concentration of propofol （HPLC）. Pharmacokinetic data were analyzed by 3P97 pharmacokinetic software. Results The two groups were comparable with respect to demographic data. Blood propofol concentrations were significantly lower in HHD group than in control group at 1, 2, 4, 6, 10 min after propofol injection （ P 〈 0.01）, thereafter there was no significant difference in plasma propofol concentration between the two groups （ P 〉 0.05 ）. The pharmacokinetic profde of propofol was well described by a standard three-compartment model. In HHD group Vc was significantly increased, K10 and C1 were significantly decreased and T1/2γ was significantly prolonged as compared with control group. Concl

关 键 词：血液稀释 异丙酚 药代动力学 高容量血液稀释 全髋置换术 

分 类 号：R614[医药卫生—麻醉学]