国产舒芬太尼在先天性心脏病与风湿性瓣膜病患者药代动力学比较

目的研究国产舒芬太尼在先天性心脏病(CHD)与风湿性瓣膜病(RHD)手术患者的药代动力学,并进行比较。方法随机选择择期CHD与RHD手术患者16例,分为CHD组和RHD组2组,各8例。静脉注射舒芬太尼5μg.kg-1,用液相色谱-质谱联用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。结果舒芬太尼的药代动力学符合开放的三室模型,其三指数函数在CHD组和RHD组分别为Cp(t)=12.79e-0.4571t+3.3295e-0.0462t+0.3999e-0.0048t和Cp(t)=24.84e-0.5260t+5.3774e-0.0523t+0.1602e-0.0017t。2组间药代动力学参数均有显著性差异(P<0.05)。RHD患者Vd、t1/2β和AUC分别是CHD组的2,2.8,1.4倍,而CHD组的Vc是RHD组Vc的1.8倍(P<0.05)。结论舒芬太尼CHD与RHD患者的药代动力学均符合三室模型,所患疾病与手术类型可影响舒芬太尼的药代动力学特征。

Comparison of sufentanil pharmacokinetics in patients with congenital heart disease and rheumatic valvular disease

Objective To compare pharmacokinetics of sufentanil in patients with congenital heart disease(CHD) and rheumatic valvular disease(RHD).MethodsSixteen ASA grade Ⅱ or Ⅲ patients undergoing open heart surgery were choiced randomly and divided into two groups: CHD group and RHD group.ResultsSufentanil pharmacokinetics was most appropriately described by a three-compartment open model in patients with RHD and CHD.The plasma concentration-time curve with three exponential function can be used: Cp(t)= 12.79e-0.4571t+3.3295e-0.0462t+0.3999e-0.0048tand Cp(t)=24.84e-0.5260t+5.3774e-0.0523t+0.1602e-0.0017t.There were significant differences in pharmacokinetic parameters between two groups(P<0.05).Vd,t1/2β and AUC value in patients with RHD group were 2.0,2.8,1.4 times than those in CHD group,while Vc value in CHD group was 1.8 times than that in RHD group.ConclusionPharmacokinetics of sufentanil were most appropriately described by a three-compartment open model,different cardiac surgery can affect sufentanil’s pharmacokinetics characteristics.