肾衰患者使用盐酸罗哌卡因硬膜外麻醉的药动学研究

Pharmacokinetics of ropivacaine during epidural anesthesia in patients with renal failure

目的 比较研究肾功能衰竭患者及肾功能正常患者分别使用盐酸罗哌卡因硬膜外麻醉后 ,机体系统的吸收、分布、代谢、排泄情况。方法 8名肾功能衰竭患者 (肾移植患者 )和 8名肾功能正常患者使用 1.6mg·kg-1盐酸罗哌卡因 ( 75mg·10mL-1)硬膜外麻醉 ,麻醉后于不同时间同时抽取动脉血和静脉血 ,用HPLC方法测定其血药浓度的数据 ,用 3P97计算药动学参数。结果 同一组之间动脉与静脉的药动学参数均无显著差异 ,表明罗哌卡因硬膜外麻醉后对于动脉和静脉的药动学过程基本一致 ;肾衰组与肾功能正常组相比 ,动脉血的消除半衰期t1/ 2 β显著延长 [分别为 ( 173.81± 4 1.14 )和 ( 12 0 .14± 34.79)min ,P =0 .0 2 ],静脉血的消除半衰期t1/ 2 β显著延长 [分别为 ( 182 .79± 5 9.0 8)和 ( 10 8.37± 4 0 .0 9)min ,P =0 .0 0 5 ]。结论 使用罗哌卡因硬膜外麻醉后动脉和静脉的药动学过程基本一致 ,肾衰患者的消除半衰期明显长于肾功能正常组 ,肾功能衰竭影响了罗哌卡因在体内的消除 ,提示肾衰患者使用罗哌卡因硬膜外麻醉时的剂量应酌减。

OBJECTIVE: To investigate the pharmacokinetics of ropivacaine during epidural anesthesia in the patients with renal failure. METHODS: 8 patients with renal failure and 8 healthy volunteers received 1.6 mg&middotkg -1 ropivacaine hydrochloride (7.5 mg &middotmL-1) epidurally. The peripheral arterial and venous blood samples were collected. The plasma concentrations of ropivacaine were measured using HPLC. RESULTS: There was a significant difference for elimination half-life t 1/2β between the two groups (P < 0. 05) and there were no significant differences for the other pharmacokinetic parameters. CONCLUSION: The elimination half-life was longer in the patients with renal failure than that in the healthy volunteers. This difference may be caused by a slower elimination of ropivacaine through kidney in patients with renal failure. Our results suggested that ropivacaine dose should be reduced accordingly in clinical practice for the patients with renal failure.