异丙酚用于结核性脓胸患者全身麻醉的药动学研究
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摘要
目的:了解胸外科结核性脓胸患者全麻中丙泊酚药代动力学特征,提高其应用的安全性,为临床合理使用丙泊酚提供依据。方法:选取2011年6月-2013年12月在本院择期胸外科手术患者46例,其中结核脓胸患者为A组23例,非结核病患者为B组23例,两组麻醉诱导药物相同,在前臂背侧静脉按2 mg/kg的剂量单次静脉给予丙泊酚,20 s注射完毕。在注射前及注射后各时间点经桡动脉采血1.5 m L,经抗凝离心提取后,采用高效液相色谱法紫外吸收检测异丙酚血药浓度。通过DAS 3.2.7软件分析药动学参数。结果:(1)两组患者的性别构成、年龄、体质量、身高、术前谷丙转氨酶、血浆中白蛋白、血色素水平和术中出血量比较,差异均无统计学意义(P>0.05)。(2)两组数据经计算机软件智能化处理符合三室开放模型,在结核性脓胸患者中清除率(CL)为(33.3±3.7)m L·kg~(-1)·min~(-1),高于非结核患者的(29.8±3.9)m L·kg~(-1)·min~(-1),差异有统计学意义(P<0.05)。在结核性脓胸患者中,慢速分布半衰期(t_(1/2))为(19.3±4.5)min,明显快于非结核患者的(25.2±6.1)min,差异有统计学意义(P<0.05)。结论:异丙酚在结核性脓胸患者的药代动力学参数与非结核病脓胸患者比较,除清除率明显加快,消除半衰期明显缩短外,其他参数未有明显变化。
AIM: To investigate the pharmacokinetics of propofol in patients with tuberculosis pyothorax during general anaesthesia,and explore the reasonable usage of propofol in tuberculosis patients,therefore enhance the safety and efficacy use of propofol in practice. METHODS: 46 adult patients with pyothorax under elective thoracic surgery with general anaesthesia were selected during June 2011 to December 2013 in Hangzhou Red Cross Hospital.They were assigned to two groups by whether tuberculosis or not: tuberculosis pyothorax group called A group and none was B group,23 cases respectively.All participants received propofol single bolus dose 2mg / kg through the forearm vein in 20 seconds.1. 5 m L arterial blood samples were withdrawn at different time points. The samples were extracted and measured by high performance liquid chromatography-ultraviolet( HPLC-UV) after centrifuged and anticoagulated. The pharmacokinetics parameters were analyzed by soft DAS 3. 2. 7. RESULTS:( 1)There was no significant difference between two groups in gender,age,body weight and height,glutamic-pyruvic transaminase,plasma albumin,hemoglobin level and intraoperative blood loss before the operation( P > 0. 05).( 2) The serum concentration-time curve was in line with three compartment model. There was a significant difference between two groups in t1 /2β,CL( P < 0. 05). The level of CL in A group was( 33. 3 ± 3. 7) m L·kg~(-1)·min~(-1),faster than that of B group[( 29. 8 ± 3. 9) m L·kg~(-1)·min~(-1)]. The level of t1 /2in A group was( 19. 3 ±4. 5) min, which was significantly shorter than( 25. 2 ± 6. 1) min in B group. CONCLUSION:Pharmacokinetics of propofol in patients with tuberculosis pyothorax under general anaesthesia show significantly different t_(1 /2),CLb than patients with none tuberculosis pyothorax. And the other pharmacokinetic parameters of propofol are not significantly different.
AIM: To investigate the pharmacokinetics of propofol in patients with tuberculosis pyothorax during general anaesthesia,and explore the reasonable usage of propofol in tuberculosis patients,therefore enhance the safety and efficacy use of propofol in practice. METHODS: 46 adult patients with pyothorax under elective thoracic surgery with general anaesthesia were selected during June 2011 to December 2013 in Hangzhou Red Cross Hospital.They were assigned to two groups by whether tuberculosis or not: tuberculosis pyothorax group called A group and none was B group,23 cases respectively.All participants received propofol single bolus dose 2mg / kg through the forearm vein in 20 seconds.1. 5 m L arterial blood samples were withdrawn at different time points. The samples were extracted and measured by high performance liquid chromatography-ultraviolet( HPLC-UV) after centrifuged and anticoagulated. The pharmacokinetics parameters were analyzed by soft DAS 3. 2. 7. RESULTS:( 1)There was no significant difference between two groups in gender,age,body weight and height,glutamic-pyruvic transaminase,plasma albumin,hemoglobin level and intraoperative blood loss before the operation( P > 0. 05).( 2) The serum concentration-time curve was in line with three compartment model. There was a significant difference between two groups in t1 /2β,CL( P < 0. 05). The level of CL in A group was( 33. 3 ± 3. 7) m L·kg~(-1)·min~(-1),faster than that of B group[( 29. 8 ± 3. 9) m L·kg~(-1)·min~(-1)]. The level of t1 /2in A group was( 19. 3 ±4. 5) min, which was significantly shorter than( 25. 2 ± 6. 1) min in B group. CONCLUSION:Pharmacokinetics of propofol in patients with tuberculosis pyothorax under general anaesthesia show significantly different t_(1 /2),CLb than patients with none tuberculosis pyothorax. And the other pharmacokinetic parameters of propofol are not significantly different.
引文
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[6]刘振威,胡卓汉,蔡映云.异烟肼和利福平联合用药对健康成人原代肝细胞CYP450同工酶1A2和3A4活性的影响[J].中华结核和呼吸杂志,2005,28(11):785-788.
[7]张倩邢,玉英.影响丙泊酚药代动力学及药效学的因素[J].国际麻醉学与复苏杂志,2008,29(5):425-428.
[8]刘瑜,高瑞,陈昱.抗结核药所致肝损害与药物代谢酶等基因多态性的关联研究[J].中国临床药理学与治疗学,2015,20(1):91-95.
[9]朱欣欣,刘朝敏.儿童药物性肝损害[J].临床肝胆病杂志,2012,28(12):896-898.
[2]Adeishvili-Andguladze LV,Makharadze RV,Kurtsikidze MSh,et al.Investigation of conjugation and metabolism of propofol with the method of high performance liquid chromatography[J].Georgian Med News,2009,169:98-100.
[3]Song JC,Sun YM,Zhang MZ,et al.Propofol pharmacokinetics in patients with obstructive jaundice[J].Curr Drug Deliv,2009,6(3):317-320.
[4]李玉红,王莉琴,付素娥,等.国人异丙酚群体药代动力学参数[J].中华麻醉学杂志,2003,23(3):173-177.
[5]Schnider TW,Minto CF,Gambus PL,et al.The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers[J].Anesthesiology,1998,88(5):1170-1182.
[6]刘振威,胡卓汉,蔡映云.异烟肼和利福平联合用药对健康成人原代肝细胞CYP450同工酶1A2和3A4活性的影响[J].中华结核和呼吸杂志,2005,28(11):785-788.
[7]张倩邢,玉英.影响丙泊酚药代动力学及药效学的因素[J].国际麻醉学与复苏杂志,2008,29(5):425-428.
[8]刘瑜,高瑞,陈昱.抗结核药所致肝损害与药物代谢酶等基因多态性的关联研究[J].中国临床药理学与治疗学,2015,20(1):91-95.
[9]朱欣欣,刘朝敏.儿童药物性肝损害[J].临床肝胆病杂志,2012,28(12):896-898.