氯胺酮对丙泊酚药动学与药效学的影响研究

目的:研究氯胺酮对丙泊酚静脉麻醉后药动学、药效学的影响。方法:24例门诊无痛人流术患者随机分为2.5mg·kg-1丙泊酚静脉麻醉组(A组,n=8)、复合0.25mg·kg-1氯胺酮组(B组,n=8)及复合0.75mg·kg-1氯胺酮组(C组,n=8)。分别在停止注射丙泊酚后0、2、4、6、8、10、15、30、45min与1、2、3h及唤醒、清醒时采集未注药侧肘静脉血,用高效液相色谱法测定单次给药后各时点丙泊酚血药浓度,并由3p97软件处理计算出药动学参数,同时监测相应时间点收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SpO2)。结果:与A组比较,B、C组的t1/2α、Vd呈减少趋势(A、C组比较:P<0.05);B、C组的K12、CL呈增加趋势(A、C组比较:P<0.05)。3组间t1/2β、K21、K10差异无统计学意义。停止注射丙泊酚后1～4min血压、HR、SpO2变化明显,SBP、DBPA、C组比较:P<0.05或B、C组比较:P<0.05;HRA、C组比较:P<0.05;SpO2A、C组比较:P<0.05。结论:单次静脉注射氯胺酮0.75mg·kg-1可促进丙泊酚的分布或再分布,而氯胺酮0.25mg·kg-1对丙泊酚分布或再分布无明显影响。2.5mg·kg-1丙泊酚复合0.25mg·kg-1氯胺酮用于无痛人流术安全、有效。

Effects of Ketamine on Pharmacokinetics and Pharmacodynamics of Propofol

OBJECTIVE：To study the effects of ketamine on pharmacokinetics and pharmacodynamics of propofol. METHODS：24 outpatients undergoing painless abortion were randomly assigned into group A（2.5 mg·kg-1propofol via i.v.,n=8）, group B（propofol combined with 0.25 mg·kg-1 ketamine,n=8）and groups C（propofol combined with 0.75 mg·kg-1 ketamine, n=8）. Blood samples were taken from basilical vein or brachial veins at 0 min,2 min,4 min,6 min,8 min,10 min,15 min, 30 min,45 min,1 h,2 h,3 h after medication,and at wake-up time and sober moments. Plasma concentrations of propofol were measured by HPLC and pharmacokinetic parameters were calculated using 3p97 software. SBP,DBP,HR and SpO2 were detected. RESULTS：Compared with group A,t1/2α and Vd in group B and group C decreased（group A vs. group C,P0.05）. K12 and CL in group B and group C increased（group A vs. group C,P0.05）. There was no statistical significance in difference of t1/2β,K21, K10 among three groups. SBP,DBP,HR and SPO2 were obviously differences at 1～4 min after injection. SBP and DBP in group C were higher than in group A and group B（P0.05 or P0.05）;HR in group C was significantly higher than in group A（P 0.05）;SpO2 in group C was distinctly lower than in group A（P0.05）. CONCLUSION：Single dose of 0.75 mg·kg-1 ketamine may promote propofol distribution or redistribution while 0.25 mg·kg-1 ketamine has no significant effects on it. Propofol（2.5 mg· kg-1）combined with ketmine（0.25 mg·kg-1）is safe and effective for painless abortion.