不同体质量肥胖患儿全麻时瑞芬太尼药代动力学研究
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摘要
目的比较不同体质量肥胖患儿全麻时瑞芬太尼药代动力学参数。方法选取2014—2018年南京市儿童医院收治择期行扁桃体腺样体肥大手术治疗需要全麻气管插管的不同体质量肥胖患儿120例为研究对象,根据体质量标准分为轻度肥胖组(n=40)、中度肥胖组(n=40)和重度肥胖组(n=40),分别应用瑞芬太尼进行全身麻醉,收集所有患者各时间点的血浆,采用高效液相色谱法检测血浆中瑞芬太尼药物代谢动力学参数及血药浓度,并比较3组之间有无差异。结果 3组体质量、BMI比较,差异均有统计学意义(P<0.05)。重度肥胖组药物峰值浓度(ρ_(max))、药物曲线下面积(ρ_(AUC))、血浆清除率(CL)、药物消除半衰期(t_(1/2)β)、表观分布容积(V_d)均高于轻度肥胖组和中度肥胖组(P<0.05),停药10、15、30、60 min后重度肥胖组血药浓度均低于轻度肥胖组和中度肥胖组(P<0.05)。结论随着患儿肥胖程度的增加,ρ_(max)增加,V_d越大,且t_(1/2)β相对延长。
Objective To compare the pharmacokinetic parameters of remifentanil during general anesthesia in obese children with different body mass. Methods There were significant differences in body mass and BMI among the three groups(P<0.05). 120 obese children with different body mass who were treated by surgery in Nanjing Children's Hospital from 2014 to 2018 were selected as subjects. They were divided into mild obesity group(n=40), moderate obesity group(n=40)and severe obesity group(n=40)according to body mass standard. Remifentanil was used for general anesthesia, and plasma of all patients at different time points was collected. High performance liquid chromatography was used. The plasma concentration and pharmacokinetic parameters of remifentanil were measured. The differences among the three groups were compared. Results The levels of ρmax、ρAUC、CL、t1/2β and Vd in severe obesity group were significantly higher than those in mild obesity group and moderate obesity group(P<0.05), and the blood concentration in severe obesity group was lower than that in mild obesity group and moderate obesity group after 10 minutes, 15 minutes, 30 minutes and 60 minutes(P<0.05). Conclusion With the increase of obesity in children, ρmax increases, Vd increases, and t1/2β prolongs relatively.
Objective To compare the pharmacokinetic parameters of remifentanil during general anesthesia in obese children with different body mass. Methods There were significant differences in body mass and BMI among the three groups(P<0.05). 120 obese children with different body mass who were treated by surgery in Nanjing Children's Hospital from 2014 to 2018 were selected as subjects. They were divided into mild obesity group(n=40), moderate obesity group(n=40)and severe obesity group(n=40)according to body mass standard. Remifentanil was used for general anesthesia, and plasma of all patients at different time points was collected. High performance liquid chromatography was used. The plasma concentration and pharmacokinetic parameters of remifentanil were measured. The differences among the three groups were compared. Results The levels of ρmax、ρAUC、CL、t1/2β and Vd in severe obesity group were significantly higher than those in mild obesity group and moderate obesity group(P<0.05), and the blood concentration in severe obesity group was lower than that in mild obesity group and moderate obesity group after 10 minutes, 15 minutes, 30 minutes and 60 minutes(P<0.05). Conclusion With the increase of obesity in children, ρmax increases, Vd increases, and t1/2β prolongs relatively.
引文
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[9]张静,刘鹏飞,胡晓云,等.淋巴水肿患者全身麻醉诱导期按不同体质量使用罗库溴铵的药效动力学比较[J].检验医学与临床,2016,13(z2):169-171.
[10]陈甜子,角述兰,杨柳.瑞芬太尼在全身麻醉中应用的研究进展[J].医学综述,2017,23(7):1393-1396,1401.
[11]陈丽,刘华,康力,等.3个年龄段全麻中瑞芬太尼、丙泊酚最佳配伍维持剂量间量效关系比较[J].现代中西医结合杂志,2018,27(15):1603-1606,1610.
[12]TIAN Y,WU X Y,LI L,et al.A clinical trial evaluating the laryngeal mask airway-supreme in obese children during general anesthesia[J].Arch Med Sci,2017,13(1):183-190.
[13]瞿昌晶,郭旋,钱淑雯.肥胖程度对顺式阿曲库铵药物代谢动力学参数的影响[J].世界临床药物,2017,38(12):835-840.
[2]KUROIWA K K,NISHIZAWA M,KONDO N,et al.Remifentanil for sedation and analgesia during awake division of tongue flap in children:a report of two cases[J].JA Clin Rep,2017,3(1):43.
[3]司马靓杰,王胜,郭素香.瑞芬太尼、芬太尼及瑞芬太尼-芬太尼联合应用对肥胖患者麻醉后苏醒质量的研究[J].现代生物医学进展,2011,11(5):909-914.
[4]BENEVIDES M L,BRAND?O V C,LOVERA J I.Perioperative management of a morbidly obese pregnant patient undergoing cesarean section under general anesthesia-case report[J].Rev Bras Anestesiol,2016,66(4):418-422.
[5]李佳阳,邹启荣,彭雪梅.顺式阿曲库铵按去脂肪体质量诱导麻醉对病态肥胖患者药代动力学的影响[J].南方医科大学学报,2016,36(10):1396-1400.
[6]韦克,邓军,黄仕英.瑞芬太尼、芬太尼在肥胖患者麻醉中的应用观察[J].实用临床医药杂志,2014,18(7):97-99.
[7]CAPPUCCIO E,THUNG A K,TOBIAS J D.General anesthesia with dexmedetomidine and remifentanil in a neonate during oracotomy and resection of a congenital cystic adenomatoid malformation[J].J Pediatr Pharmacol Ther,2018,23(3):215-218.
[8]ZHANG Y H,LU H M,FU Z,et al.Effect of remifentanil for general anesthesia on parturients and newborns undergoing cesarean section:a meta-analysis[J].Minerva Anestesiol,2017,83(8):858-866.
[9]张静,刘鹏飞,胡晓云,等.淋巴水肿患者全身麻醉诱导期按不同体质量使用罗库溴铵的药效动力学比较[J].检验医学与临床,2016,13(z2):169-171.
[10]陈甜子,角述兰,杨柳.瑞芬太尼在全身麻醉中应用的研究进展[J].医学综述,2017,23(7):1393-1396,1401.
[11]陈丽,刘华,康力,等.3个年龄段全麻中瑞芬太尼、丙泊酚最佳配伍维持剂量间量效关系比较[J].现代中西医结合杂志,2018,27(15):1603-1606,1610.
[12]TIAN Y,WU X Y,LI L,et al.A clinical trial evaluating the laryngeal mask airway-supreme in obese children during general anesthesia[J].Arch Med Sci,2017,13(1):183-190.
[13]瞿昌晶,郭旋,钱淑雯.肥胖程度对顺式阿曲库铵药物代谢动力学参数的影响[J].世界临床药物,2017,38(12):835-840.