全麻患者静脉输注国产阿芬太尼的药代动力学  

Pharmacokinetics of intravenously infused domestic alfentanil in patients undergoing general anesthesia

作　　者：杨小娟[1] 吴超然[2] 

机构地区：[1]重庆医科大学附属第一医院麻醉科,400016 [2]四川大学华西医院麻醉科,成都市610041

出　　处：《中华麻醉学杂志》2016年第3期335-338,共4页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金面上项目（81471141,81271238）

摘　　要：目的 探讨全麻患者静脉输注国产阿芬太尼的药代动力学.方法 择期全麻下行甲状腺次全切除术患者12例,年龄18～47岁,体重49～ 86 kg,性别不限,ASA分级Ⅰ或Ⅱ级.静脉注射眯达唑仑0.02 mg/kg、阿芬太尼25 μg/kg、异丙酚1.5 mg/kg和罗库溴铵0.8 mg/kg,气管插管后接呼吸机行机械通气,麻醉维持：吸入0.8％ ～2.0％七氟醚,静脉输注阿芬太尼1μg· kg-1·min-1,间断静脉注射罗库溴铵10～20 mg,维持BIS值40 ～ 60,手术结束前10 min时停止输注阿芬太尼.分别于麻醉诱导前、静脉输注阿芬太尼1、3、5、8、10、14、20、35、65、95、125 min及停止输注后5、15、30、60、120、180、240、300和360 min时采集静脉血样4 ml,采用高效液相色谱-质谱联用法测定血浆阿芬太尼浓度.采用DAS 3.0软件分析阿芬太尼药代动力学参数.结果 国产阿芬太尼药代动力学适用二室模型描述,其分布半衰期为（1.8±0.8） min,消除半衰期为（91±22） min;稳态分布容积为（0.38±0.12）L/kg;清除率为（4.3±1.6） ml· kg-1·min-1;国产阿芬太尼的消除符合一级消除动力学.结论 全麻患者静脉输注国产阿芬太尼的分布符合二室模型,其消除符合一级消除动力学.Objective To investigate the pharmacokinetics of intravenously infused domestic alfentanil in the patients undergoing general anesthesia.Methods Twelve American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 18-47 yr,weighing 49-86 kg,scheduled for elective subtotal thyroidectomy under general anesthesia,were enrolled in the study.Anesthesia was induced with iv midazolam 0.02 mg/kg,alfentanil 25 μg/kg,propofol 1.5 mg/kg and rocuronium 0.8 mg/kg.The patients were endotracheally intubated and mechanically ventilated.Anesthesia was maintained with inhalation of 0.8%-2.0% sevoflurane,iv infusion of alfentanil 1 μg · kg-1 · min-1,and intermittent iv boluses of rocuronium 10-20 mg,bispectral index value was maintained at 40-60,and infusion was stopped at 10 min before the end of surgery.Before induction of anesthesia,at 1,3,5,8,10,14,20,35,65,95 and 125 min ofalfentanil infusion,and at 5,15,30,60,120,180,240,300 and 360 min after termination of alfentanil infusion,venous blood samples were collected for determination of the plasma concentration of alfentanil （by high performance liquid chromatography-mass spectrometry/mass spectrometry）.DAS 3.0 software was used to analyze the pharmacokinetic parameters of alfentanil.Results The pharmacokinetics of domestic alfentanil was best described by a two-compartment pharmacokinetic model.The distribution half-life was （1.8 ± 0.8） min,and the elimination half-life was （91±22） min.The volume of distribution at steady state was （0.38±0.12） L/kg,and the clearance was （4.3± 1.6） ml · kg-1 · min-1.The elimination of domestic alfentanil followed the first-order kinetics.Conclusion The distribution of intravenously infused domestic alfentanil is fitted to a two-compartment pharmacokinetic model with elimination following the first-order kinetics in the patients undergoing general anesthesia.

关 键 词：阿芬太尼 药代动力学 输注 静脉内 

分 类 号：R969.1[医药卫生—药理学]