肥胖患者静脉麻醉药应用及剂量调整  

Dose adjustment and application of intravenous anaesthetics in obese patients

作　　者：磨凯[1] 徐世元[1] 刘中杰[1] 李凤仙[1] 梁启波[1] 张庆国[1] 

机构地区：[1]南方医科大学珠江医院麻醉科,510282

出　　处：《国际麻醉学与复苏杂志》2013年第6期537-540,547,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：背景 肥胖患者麻醉药药代与药效动力学较体重正常人群个体差异更大,其心输出量与身体肌肉、脂肪等组织构成比的变化影响众多麻醉药物分布、消除规律,按总体重给药易致药物过量,按理想体重给药则可能剂量不足. 目的 阐述常用静脉麻醉药在肥胖患者中的药代与药效动力学特性,有助于此类患者合理用药,减少并发症. 内容 综述肥胖患者常用静脉麻醉药按总体重、理想体重、体表面积和瘦体重用药研究现状. 趋势 为避免肥胖患者肌松药术后残余作用所致并发症,非去极化肌松药按理想体重给药较合适,而大多数静脉麻醉药（包括阿片类药物）则适于按瘦体重给药.Background Obese patients have greater inter-individual variations than the standard-size patients in the anesthetic pharmacokinetics and pharmacodynamics.In obese population,changes in cardiac output and alterations in body composition affect the distribution of numerous anaesthetics,therefore,administration of drugs based on total body weight could result in overdose,conversely,administration of drugs based on ideal body weight could result in an inadequate dose.Objective This review focuses on the pharmacokinetics and pharmacodynamics properties of intravenous anesthetic in obese patients in order to provide recommendation for rational application of intravenous anesthetic in obese patients and reduce complications.Content Discussing dosing scalars based on total body weight,ideal body weight,body surface area and lean body weight as well as its recent advances in clinical application of intravenous anaesthetics in the obese.Trend To avoid postoperative residual curarization,the ideal body weight might be appropriate for dosing scalar of the non-depolarizing neuromuscular blocking agents,whereas,lean body weight is the optimal dosing scalar for the majority of anaesthetic agents including opioids and anaesthetic-induction agents for obese patients.

关 键 词：肥胖 麻醉药 药效动力学 药代动力学 

分 类 号：R614[医药卫生—麻醉学]