摘要
目的 探讨罗库溴铵在不同程度烧伤患者体内的药物代谢动力学(简称药动学)特征。方法 选取医院2018年6月至11月收治并择期行烧伤手术的患者45例,按烧伤程度的不同分为对照组(行瘢痕切除修复植皮术)、中度烧伤组(行切痂植皮术)、重度烧伤组(行切痂植皮术),各15例。3组患者均以0.4 ng/mL的速率靶控输注舒芬太尼,在达有效镇痛质量浓度(0.35 ng/mL)后依次静脉注射依托咪酯0.4 mg/kg及罗库溴铵0.9 mg/kg行麻醉诱导,麻醉维持采用静吸复合方式,术中均靶控输注舒芬太尼(速率为0.4 ng/mL),静脉持续泵注右美托咪定0.4μg/(kg·h),并联合吸入2%七氟烷。分别于麻醉诱导后1,3,5,10,15,20,30,40,50,60,90 min,停止靶控输注时,以及停药后1,3,5,8,10,20 min抽取动脉血,并用高效液相色谱串联质谱法测定罗库溴铵血药浓度,并拟合最佳房室模型,计算药动学参数。结果 重度烧伤组患者麻醉诱导后的罗库溴铵血药浓度,诱导后1 min明显低于对照组,其余时点均明显低于另两组(P <0.05)。重度烧伤组的罗库溴铵中央室分布容积、表观分布容积和清除率均明显大于另两组,消除半衰期、平均滞留时间均明显短于另两组,中央室消除常数明显小于另两组(P <0.05)。3组患者术中均未发生体动,术后30 min恢复自主呼吸,顺利拔管。结论 罗库溴铵在重度烧伤患者高代谢期的药动学变化明显,临床应用中可适当增加给药剂量,以提供充分的肌肉松弛条件,且重度烧伤患者单次给药时予0.9 mg/kg罗库溴铵的肌肉松弛效果良好。
Objective To investigate the pharmacokinetic characteristics of rocuronium bromide in patients with different degrees of burn.Methods A total of 45 patients admitted to the hospital from June to November 2018 and planned to undergo the burn surgery were selected and divided into the control group(undergoing scar excision,repair and cutaneous autografting),the moderate burn group(undergoing scab excision and cutaneous autografting)and the severe burn group(undergoing scab excision and cutaneous autografting)based on different degrees of burn,with 15 cases in each group.Three groups were given target-controlled infusion(TCI)of sufentanil at a rate of 0.4 ng/mL,and intravenous injection of etomidate(0.4 mg/kg)and rocuronium bromide(0.9 mg/kg)for anesthesia induction was conducted after the effective analgesic mass concentration reaching 0.35 ng/mL.The anesthesia was maintained by a combination of intravenous anesthesia and inhalation anesthesia.During the surgery,three groups were given TCI of sufentanil(at a rate of 0.4 ng/mL),continuous intravenous pump of dexmedetomidine[0.4μg/(kg·h)]and inhalation of 2%sevoflurane.Arterial blood was drawn at 1,3,5,10,15,20,30,40,50,60,90 min after anesthesia induction,at the time of TCI stopping,at 1,3,5,8,10,20 min after drug withdrawal.The blood concentration(C)of rocuronium bromide was determined by the high-performance liquid chromatography-tandem mass spectrometry(HPLC-MC/MS),the optimal atrioventricular model was fitted,and the pharmacokinetic parameters were calculated.Results The C of rocuronium bromide in the severe burn group at 1 min after anesthesia induction was significantly lower than that in the control group,and that in the severe burn group at other time points was significantly lower than that in the control group and moderate burn group(P<0.05).Compared with those in the control group and moderate burn group,the central compartment distribution volume(V_(1)),apparent distribution volume(Vd)and clearance rate(CL)of rocuronium bromide in the severe burn group were significantly higher,the elimination half-life(t1/2γ)and mean residence time(MRT)was significantly shorter,the central compartment elimination constant(K10)was significantly lower(P<0.05).No body movement occurred in the three groups during the surgery,the spontaneous breathing was restored 30 min after the surgery,and the extubation was successful.Conclusion Rocuronium bromide has obvious pharmacokinetic changes in severe burn patients at hypermetabolic stage.We can increase the dosage appropriately for good muscle relaxation conditions in clinical practice.In severe burn patients,rocuronium bromide given at a single dose of 0.9 mg/kg has a good effect on muscle relaxation.
作者
黄瑞萍
卜莹慧
角述兰
李灿兴
李梦帆
思永玉
周艺蕉
向兵兵
HUANG Ruiping;BU Yinghui;JIAO Shulan;LI Canxing;LI Mengfan;SI Yongyu;ZHOU Yijiao;XIANG Bingbing(The Second Affiliated Hospital of Kunming Medical University,Kunming,Yunnan,China 650101)
出处
《中国药业》
CAS
2023年第22期73-77,共5页
China Pharmaceuticals
基金
云南省科技计划项目[2014FZ027]。
关键词
烧伤
罗库溴铵
药物代谢动力学
麻醉
肌肉松弛
burn
rocuronium bromide
pharmacokinetic
anesthesia
muscle relaxation
