舒芬太尼在心脏瓣膜置换术患者的药代动力学

Pharmacokinetics of sufentanil in patients undergoing mitral valve replacement

目的研究舒芬太尼(麻醉药)于体外循环下二尖瓣置换术(MVR)患者的药代动力学。方法随机选择NYHAⅡ～Ⅲ级的MVR患者8例,麻醉后前臂静脉注射舒芬太尼5μg.kg-1。在静脉注射舒芬太尼前和注射后1,3,5,10,20,30,60,120,180,240和360min,采肝素抗凝血浆1mL置入密封真空试管中,-80℃低温保存至分析。用液相色谱-质谱联用法测定血浆舒芬太尼浓度,3P97药理学程序计算药代动力学参数。结果舒芬太尼在MVR患者的药代动力学符合三室开放模型,药物浓度与时间曲线可用三指数函数方程表示。主要药代动力学参数t1/2π=(1.39±0.36)min,t1/2α=(14.03±4.46)min,t1/2β=(410.34±41.33)min,Vc=(0.18±0.05)L.kg-1,Vd=(12.01±2.99)L.kg-1,CL=(0.02±4×10-3)L.kg-1.min-1和AUC=(253.85±55.76)ng.mL-1.min。结论舒芬太尼在MVR患者药代动力学符合三室开放模型,体外循环与血液稀释及患者的心功能状态将影响其药代动力学特征。

Objective To investigate pharmacokinetics of sufentanil in patients undergoing mitral valve replacement （MVR）. Methods Eight NYHA grade Ⅱ or Ⅲ patients undergoing mitral valve replacement were studied. Intravenous and intra - arterial cannulae were placed. After general anesthesia sufentanil 5 μg· kg-1 was administered as a rapid bolus intravenously. Blood samples were obtained before and 1,3,5,10,20, 30,60,120,180,240 and 360min after sufentanil injection. 1 mL plasma was immediately separated from blood samples and stored at -80℃ until analyzed. Plasma sufentanil concentration were determined by liquid chromatography- mass spectrometry, and pharmacokinetie parameters were calculated by 3P97 pharm -aeology program. Results Pharmaco- kinetics of sufentanil fitted to three - compartment open model, and de- scribed by the three -exponential equation. Pharmacokinetic parameters were t1/2π = （ 1.39 ± 0. 36） rain, t1/2 α = （ 14.03 ± 4. 46） rain, t1/2 β = （410.34±41.33） min, Vc = （0.18±0.05） L ·kg-1,Vd = （12.01 ± 2.99） L· kg-1 ,CL = （0. 02 ±4 × 10-3） L· kg-1·min-1 and AUC = （253.85 ± 55.76） ng ·mL-1 . rain. Conclusion Pharmacokinetics of sufentanil could be described by open three - compartment model. The eardiopulmonary bypass and patient＇ s cardiac function would affect the pharmacokinetics characteristics.