先心病患者体外循环对舒芬太尼药代动力学的影响

目的研究先心病心内矫治术患者低温体外循环对舒芬太尼药代动力学的影响。方法随机选择NYHAⅡ～Ⅲ级的先心病手术患者16例,分为先心病普通手术组(n=7)和体外循环下先心病矫治手术组(n=9)。入室后建立前臂静脉通路,麻醉后一次性静脉注射舒芬太尼5μg.kg-1。在静脉注射舒芬太尼后1,3,5,10,20,30,60,120,240,360 min采肝素抗凝血浆1 mL。用液相色谱-质谱联用法测定血药浓度,3P97药理学程序计算药代动力学参数。结果 2组患者药代动力学可用三室模型完整描述,其三指数函数方程分别为:Cp(t)=16.6e-1.786t+6.6e-0.171t+0.23e-0.025t和Cp(t)=12.8e-0.457t+3.3e-0.046t+0.4e-0.0048t,2组的t1/2π,t1/2α,t1/2β,Vc,Vd,CL和AUC差异有统计学意义(P<0.01或P<0.05)。结论舒芬太尼在先心病患者药代动力学可用三室模型描述,低温体外循环血液稀释可影响其药代动力学特征。

Effect of cardiopulmonary bypass on the pharmacokinetics of sufentanil in patients with congenital heart disease

Objective To study effect of cardiopulmonary bypass on the pharmacokinetics of sufentanil in patients with congenital heart disease(CHD).Methods Sixteen NYHA grade Ⅱor Ⅲ patients with CHD undergoing surgery were divided into general surgery group(n=7) and cardiac surgery group(n=9).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 at 1,3,5,10,20,30,60,120,180,240,360 min after sufentanil injection.Plasma sufentanil concentrations were determined by liquid chromatography-mass spectrometry,pharmacokinetic parameters were calculated by 3P97 pharmacological program.Results Pharmacokinetics of sufentanil fitted to three-compartment open model,the tri-exponential equation were Cp(t)= 16.6e-1.786t+6.6e-0.171t+0.23e-0.025t and Cp(t)= 12.8e-0.457t+3.3e-0.046t+0.4e-0.004 8t,respectively.There were significant difference in t 1/2π,t1/2α,t1/2β,Vc,Vd,CL and AUC between two groups(P<0.01 or P<0.05).Conclusion Pharmacokinetics of domestic sufentanil in patients with CHD were fitted to three-compartment open models,cardiopulmonary bypass(CPB) and hemodilution can affect its pharmacokinetics characteristics.