Pharmacokinetic Study of Dexmedetomidine in Patients with Different Degrees of Burn
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摘要:
目的 探讨不同程度烧伤患者应用右美托咪定的药代动力学,提高烧伤患者手术的麻醉质量。 方法 选择行择期手术的烧伤患者45例,将行瘢痕切除植皮术的患者纳入A组,将烧伤程度为中度和重度的患者纳入B组和C组,每组15例。3组患者分别于麻醉诱导前10 min恒速静脉泵注右美托咪定1 μg/kg。分别在右美托咪定给药前,给药期间的第1(TCI1),3(TCI3),5(TCI5)和10(TCI10) min;停药后的2(T2),5(T5),10(T10),15(T15),20(T20),25(T25),30(T30),45(T45),60(T60),90(T90),120(T120) min采集动脉血,测定右美托咪定血浆药物浓度(Cm),计算出药代动力学参数。 结果 C组的Vd、CL、K12、K10均大于A组(P < 0.05),C组的Vd、CL均大于B组(P < 0.05),B组Vd大于A组(P < 0.05)。 结论 在重度烧伤患者中,右美托咪定的Vd、CL、K12、K10均增大,Cm减小,可适当增加给药剂量以提高麻醉质量,降低并发症的发生。 Abstract:Objective To investigate the pharmacokinetics of dexmedetomidine in burn patients with different degrees in order to improve the quality of anesthesia in burn patients. Methods Forty-five burn patients undergoing elective surgery were selected in this study. Among them, patients undergoing scar excision and skin grafting were included in group A, and patients with moderate and severe burns were respectively included in group B and group C, with 15 cases in each group. Patients in the three groups were respectively pumped dexmedetomidine 1µg/kg intravenously at a constant rate 10min before anesthesia induction. Before dexmedetomidine administration, during the administration of 1 (TCI1), 3 (TCI3), 5 (TCI5) and 10 (TCI10)min, after discontinuation of 2 (T2), 5 (T5), 10 (T10), 15 (T15), 20 (T20), 25 (T25), 30 (T30), 45 (T45), 60 (T60), 90 (T90), 120 (T120) min, we collected the arterial blood, and determined the plasma drug concentration (Cm) of dexmedetomidine. At last, we calculated the pharmacokinetic parameters. Results The Vd CL, K12, and K10 in group C were all higher than those in group A, the Vd, CL in group C were higher than those in group B, and the Vd in group B was higher than that in group A. Conclusions In severe burn patients, the Vd, CL, K12, and K10 of dexmedetomidine are increased, and Cm is decreased. The dose of dexmedetomidine can be appropriately increased to improve the quality of anesthesia and reduce complications. -
Key words:
- Burn /
- Dexmedetomidine /
- Pharmacokinetic
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表 1 一般情况比较(
$ \bar x \pm s $ )Table 1. Comparison of general information (
$ \bar x \pm s $ )项目 A组(n = 15) B组(n = 15) C组(n = 15) F P 性别(n) 3.925 0.148 男 6 14 12 女 4 1 3 年龄(岁) 42.23 ± 13.17 38.45 ± 11.51 40.46 ± 13.12 0.291 0.749 身高(cm) 163.70 ± 7.44 166.21 ± 6.33 165.30 ± 6.90 0.694 0.506 体重(kg) 62.72 ± 11.81 61.83 ± 8.64 59.66 ± 7.59 0.395 0.677 BMI(kg/m2) 23.29 ± 2.93 22.15 ± 2.18 21.84 ± 3.02 0.828 0.445 白蛋白(g/L) 41.10 ± 1.07 37.07 ± 3.96△ 31.01 ± 5.82△▲ 16.917 < 0.001* ALT(U/L) 18.52(12~30.25) 31.04(20~49) 32.06(25~89) 5.846 0.054 右美用量(μg) 62.78 ± 11.81 60.33 ± 8.47 59.60 ± 7.59 0.363 0.698 手术时间(h) 1.90 ± 0.67 1.94 ± 0.65 2.46 ± 0.83 2.17 0.129 *P < 0.05;与A组比较,△P < 0.05;与B组比较,▲P < 0.05。 表 2 血药浓度比较(
$ \bar x \pm s $ )Table 2. Comparison of plasma concentration (
$ \bar x \pm s $ )时间 A组(n = 15) B组(n = 15) C组(n = 15) F P TCI1 1.08 ± 0.20 0.60 ± 0.34△ 0.67 ± 0.28△ 9.233 0.001* TCI3 1.44 ± 0.37 1.10 ± 0.23△ 1.08 ± 0.25△ 6.15 0.005* TCI5 1.78 ± 0.48 1.44 ± 0.29△ 1.19 ± 0.18△▲ 10.299 < 0.001* TCI10 2.21 ± 0.45 1.88 ± 0.39△ 1.52 ± 0.28△▲ 10.815 < 0.001* T2 1.20 ± 0.28 1.02 ± 0.22 0.88 ± 0.24△ 5.256 0.01* T5 0.88 ± 0.18 0.73 ± 0.17△ 0.62 ± 0.14△ 7.67 0.002* T10 0.61 ± 0.12 0.59 ± 0.14 0.54 ± 0.19 0.646 0.53 T15 0.52 ± 0.13 0.49 ± 0.15 0.54 ± 0.17 0.462 0.633 T20 0.43 ± 0.10 0.43 ± 0.10 0.46 ± 0.18 0.269 0.766 T25 0.39 ± 0.08 0.39 ± 0.09 0.36 ± 0.11 0.623 0.542 T30 0.35 ± 0.08 0.35 ± 0.09 0.30 ± 0.09 1.94 0.158 T45 0.29 ± 0.07 0.30 ± 0.07 0.23 ± 0.07△▲ 4.715 0.015* T60 0.26 ± 0.06 0.25 ± 0.09 0.20 ± 0.05 2.978 0.063 T90 0.20 ± 0.04 0.21 ± 0.07 0.16 ± 0.05▲ 3.464 0.042* *P < 0.05;与A组比较,△P < 0.05;与B组比较,▲P < 0.05。 表 3 药代动力学参数(
$ \bar x \pm s $ )Table 3. Pharmacokinetic parameters (
$ \bar x \pm s $ )项目 A组(n = 15) B组(n = 15) C组(n = 15) F P CL(L/h)[(min·ng)/mL] 57.71 ± 11.47 53.46 ± 17.29 64.00 ± 16.10△▲ 1.419 0.024* Vd(mL/kg) 1289.37 ± 396.58 1455.92 ± 674.42△ 1568.87 ± 571.69△▲ 10.253 0.002* MRT(min) 29.00 ± 2.02 36.75 ± 4.83 37.91 ± 4.09 12.998 < 0.001* AUC INF [(min·ng)/mL] 70.18 ± 15.28 77.39 ± 29.43 59.54 ± 23.38 1.663 0.207 AUC last [(min·ng)/mL] 45.61 ± 9.45 47.90 ± 12.16 41.11 ± 9.89 1.269 0.296 Cmax(ng/mL) 2.19 ± 0.50 1.98 ± 0.51 1.51 ± 0.23△▲ 6.91 0.003* K10(L/min) 0.069 ± 0.024 0.075 ± 0.069 0.082 ± 0.057△ 12.350 < 0.001* K12(L/min) 0.140 ± 0.064 0.260 ± 0.177 0.300 ± 0.229△ 13.270 < 0.001* K21(L/min) 0.038 ± 0.010 0.041 ± 0.020 0.048 ± 0.029 1.514 0.212 t 1/2(min) 78.91 ± 19.24 82.13 ± 21.04 84.04 ± 28.27 1.380 0.267 *P < 0.05;与A组比较,△P < 0.05;与B组比较,▲P < 0.05。 -
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