不同体质量肥胖患儿全麻时瑞芬太尼药代动力学研究

Pharmacokinetics of Remifentanil During General Anesthesia in Obese Children with Different Body Mass

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(ρmax)、药物曲线下面积(ρAUC)、血浆清除率(CL)、药物消除半衰期(t1/2β)、表观分布容积(Vd)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,ρmax增加,Vd越大,且t1/2β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 ofρmax、ρAUC、CL、t1/2βand 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 t1/2βprolongs relatively.