芬太尼在先心病小儿心内直视手术中的药代动力学研究

The Pharmacokinetics of High dose Fentanyl in Children Undergoing Open Heart Surgery

目的与方法：用气相色谱－质谱法测定血芬太尼浓度研究非紫绀先心病小儿心内直视手术中大剂量芬太尼麻醉的药代动力学。结果：芬太尼的药代动力学符合开放性三室模型，其药代动力学参数ｔ１／２π、ｔ１／２α、ｔ１／２β分别为２．８ｍｉｎ、２５．２ｍｉｎ和２３２．２ｍｉｎ；Ｖｄ和Ｃｌ分别为４．８９Ｌ／ｋｇ和５６５．６ｍｌ·ｋｇ－１·ｍｉｎ－１。结论：本麻醉方法其血浆芬太尼浓度不能有效地抑制机体的应激反应，必须辅助小剂量吸入麻醉药。在体外循环结束后应适当补充芬太尼，方可有效地提高血浆芬太尼的治疗浓度，抑制有害的应激反应，维持血流动力学的稳定。

Objective and Methods:The pharmacokinetics of high dose fentanyl was studied in twelve patients with cogenital heart disease undergoing cardiac surgery under cardiopulmonary bypass with gas chromatography. Results:The pharmacokinetics of fentanyl best fitted a three compartment open model. The rapid distribution half life(t1/2π), slow distribution half life(t1/2α) and elimination half life(t1/2β) were 2 8min,25 2min and 232 2min respectively. The apparent volume of distribution and total body cleance were 4 89L/kg and 565 6ml·kg -1 ·min -1 respectively. No second peak during the elimination phase was found. Conclusions:Plasma concentration of fentanyl declines significantly at the end of CPB. Supplementary doses of fentanyl should be administered to inhibit the noxious responses and to keep the hemodynamics stable.