年龄因素对心脏瓣膜置换术患者舒芬太尼药代动力学的影响

目的 评价年龄因素对心脏瓣膜置换术患者舒芬太尼药代动力学的影响.方法 择期心脏瓣膜置换术患者16例,NYHAⅡ或Ⅲ级,按年龄分为老年组(Ⅰ组,年龄65 ～ 69岁,n=8)和青壮年组(Ⅱ组,年龄36～ 45岁,n=8).麻醉诱导时前臂静脉注射舒芬太尼5μg/kg.在静脉注射舒芬太尼后1、3、5、10、20、30、60、120、180、240和360 min时采集桡动脉血样3ml,采用液相色谱-质谱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 体外循环前Ⅰ组和Ⅱ组患者舒芬太尼的血药浓度-时间关系可用二指数函数方程表示,分别为Cp(t)=27.4 e-0.41t+ 3.2 e-0.029t和Cp(t)=14.4e-0.51t+3.4 e-0.032；两组t1/2α、t1/2β和CL差异有统计学意义(P＜0.05或0.01)；体外循环时两组患者舒芬太尼的血药浓度-时间关系符合三指数函数方程,分别为Cp(t)=22 e-0.51t+3.5e-0.045+0.21e-0.0029t和Cp(t)=15 e-0.52t+3.9 e-0.048t+0.32 e-0.004t,舒芬太尼的药代动力学参数比较差异无统计学意义(P＞0.05).结论 体外循环前心脏瓣膜置换术不同年龄患者舒芬太尼的药代动力学特征存在差异,体外循环时年龄因素对舒芬太尼的药代动力学无明显影响.

Effect of different ages on sufentanil pharmacokinetics in patients undergoing cardiac valve replacement

Objective To assess the effect of different ages on sufentanil pharmacokinetics in patients undergoing cardiac valve replacement.Methods Sixteen NYHA Ⅱ or Ⅲ patients undergoing selective cardiac valve replacement were randomly divided into two groups:elderly group (aged 65-69 years,group Ⅰ,n =8) and young adult group (aged 36-45 years,group Ⅱ,n =8).Intravenous and intra-arterial cannulae were placed.Sufentanil 5 μg/kg injected intravenously during anesthesia induction.Blood samples from the radial artery were obtained at 1,3,5,10,20,30,60,120,180,240 and 360 min after sufentanil injection (3 ml each).Then 1 ml plasma was immediately separated from the 3 ml blood sample and stored at - 80 ℃ until being assayed.Plasma sufentanil concentration was determined with liquid chromatography mass spectrometry and pharmacokinetic parameters were calculated with 3P97 pharmacologicl program.Results Plasma sufentanil concentration versus the time decay curve in patients undergoing cardiac valve replacement before cardiopulmonary bypass (CPB) was fitted to a twocompartment model and could be expressed by bi-exponential equations:Cp (t) =27.4 e-0.41t + 3.2 e-0.029t in group Ⅰ and Cp (t) =14.4 e-0.51t +3.4 e-0.032t in group Ⅱ,respectively.There were significant differences in t 1/2 α,t1/2 β and CL between the two groups ( P ＜ 0.05 or 0.0l ).During CPB,plasma sufentanil concentration versus the time decay curve in patients undergoing cardiac valve replacement was fitted to a three-compartment model and could be expressed by tri-exponential equations:Cp(t) =22 e-0.51t + 3.5 e-0.045t + 0.21 e-0.0029 t in group Ⅰand Cp(t) =15 e-0.52t + 3.9 e-0.048t + 0.32 e-0.004t in group Ⅱ,respectively.There were no significant differences in pharmacokinetic parameters between the two groups ( P ＞ 0.05).Conclusion There are significant differences in sufentanil phannacokinetic characteristics before CPB but different ages have no obvious influence on sufentanil pharmaco-kinetics during CPB.