血液稀释对顺式阿曲库铵药代学及药效学影响的研究

中国临床药理学与治疗学 ›› 2014, Vol. 19 ›› Issue (12): 1365-1370.

血液稀释对顺式阿曲库铵药代学及药效学影响的研究

袁晓红¹, 郭建荣², 金孝岠³

¹浙江省肿瘤医院麻醉科,杭州 310022,浙江;
²上海市浦东新区公立医院麻醉科,上海 200135;
³皖南医学院附属弋矶山医院麻醉科,芜湖 241001,安徽

收稿日期:2013-08-29 修回日期:2014-04-03 发布日期:2020-07-20
通讯作者: 郭建荣,通信作者,男,博士后,主任医师,硕士生导师,研究方向:麻醉生理与药理学研究。Tel:021-58858730 E-mail:jianrguo@126.com
作者简介:上海市浦东新区卫生系统领先人才基金(PWR12013-03)袁晓红,女,硕士,主治医师,研究方向:麻醉与器官保护。Tel:0571-88122106 E-mail:yuanxiaohong123045@163.cn

Effect of hemodilution on the pharmacokinetics and pharmacodynamics of cis-atracurium

YUAN Xiao-hong¹, GUO Jian-rong², JIN Xiao-ju³

¹Department of Anesthesiology, Zhejiang Cancer Hospital, Zhejiang 315000, Hangzhou, China;
²Department of Anesthesiology, Gong Li Hospital, Pudong New Area, Shanghai 200135, China;
³Department of Anesthesiology, Yijishan Hospital of Wannan Medical College, Wuhu 241001, Anhui, China

Received:2013-08-29 Revised:2014-04-03 Published:2020-07-20

摘要/Abstract

摘要： 目的: 研究血液稀释下顺式阿曲库铵药代学及药效学变化,为其血液稀释时的合理使用提供参考依据。方法: 择期骨科手术患者90例,ASAⅠ～Ⅱ级,35～60岁。随机分为3组(n=30):A组行急性等容血液稀释(ANH);B组行急性高容血液稀释(AHH);C组为对照组,常规输血输液。每组患者再随机分为3个亚组(n=10),顺式阿曲库铵剂量分别为 0.1、0.2、0.3 mg/kg。常规麻醉诱导后,静注相应剂量顺式阿曲库铵后气管插管。观察各组患者的肌松效应及血药浓度变化,并计算其药代学参数。结果: 同等剂量下B组肌松起效时间显著延长 (P<0.05);三组患者起效时间缩短,成串刺激(TOF)无反应期、肌松维持时间、肌松体内时间随剂量增大而延长 (P<0.05);A、B组血液稀释后血药浓度均呈剂量正相关性下降,B组下降更显著。血液稀释组 t_1/2α延长,V_c显著增大(P<0.05),其中AHH组V_c增大约1倍。结论: AHH下使用顺式阿曲库铵时,应适当增加剂量;而ANH时可不调整剂量。

关键词: 急性等容血液稀释, 急性高容血液稀释, 顺式阿曲库铵, 药代动力学, 药效动力学

Abstract: AIM: To compare the changes of pharmacokinetics and pharmacodynamics of cis-atracurium administered in different methods of hemodilution to provide a reference for clinical anesthesia. METHODS: Ninety elective orthopedic surgery patients, ASA Ⅰ-Ⅱ, 35 to 60 years old, were randomized into three groups by the different treatment methods in preoperative transfusion (n=30 each): group A acute normovolemic hemodilution (ANH),group B acute hypervolemic hemodilution (AHH) and control group (group C). Each group was divided into three subgroups(n=10 each) with the corresponding loading dose of cis-atracurium (0.1, 0.2,0.3 mg/kg). General anesthesia was induced after intravenous doses corresponding cis-atracurium after tracheal intubation. And then, we observed in each group of patients with muscle relaxant effects and changes in plasma concentration and calculated the pharmacokinetic parameters. RESULTS: The onset time of muscle relaxation was significantly longer in group B of the same dose (P<0.05). The TOF responses of free,the duration of neuromuscular block,and the body time were increased while the onset time accelerated as the dose prolonged (P<0.05).Hemodilution group significantly decreased serum concentrations positively correlated with the dose.And the reduction of group B was more pronounced.t_1/2α and V_c increased significantly in group A and B (P<0.05). And V_c in group B doubled. CONCLUSION: The dose of cis-atracurium in AHH should be appropriately increased, which could be maintained while in ANH.

Key words: acute normovolemic hemodilution, acute hypervolemic hemodilution, cis-atracurium, pharmacokinetics, pharmacodynamics

中图分类号:

R614

袁晓红, 郭建荣, 金孝岠. 血液稀释对顺式阿曲库铵药代学及药效学影响的研究[J]. 中国临床药理学与治疗学, 2014, 19(12): 1365-1370.

YUAN Xiao-hong, GUO Jian-rong, JIN Xiao-ju. Effect of hemodilution on the pharmacokinetics and pharmacodynamics of cis-atracurium[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2014, 19(12): 1365-1370.

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