Macfie A G, Magides A D, Reilly C S
Department of Anaesthesia, University of Sheffield.
Br J Anaesth. 1992 Nov;69(5):447-50. doi: 10.1093/bja/69.5.447.
We have studied the disposition of alfentanil in six patients (who had suffered 10-30% surface area burns 5-21 days previously) undergoing surgical debridement and grafting and compared the data with those from a control group of six patients matched for age, sex and weight undergoing body surface surgery of similar duration. Plasma samples were collected up to 480 min after an i.v. bolus of alfentanil 50 micrograms kg-1. Drug concentrations were measured by radioimmunoassay and alfentanil binding to plasma proteins by equilibrium dialysis. The burns patients had significantly greater concentrations of alpha-1-acid glycoprotein (AAG) and smaller concentrations of albumin. The mean protein binding of alfentanil was 94.2 (SEM 0.05)% in the burns group and 90.7 (0.4)% in the control group (P = 0.004). There was a good correlation between AAG concentration and protein binding (r = 0.8). The volume of distribution and total clearance of alfentanil were reduced significantly in the burns group. The clearance of the unbound fraction and the elimination half-life of alfentanil were not decreased significantly.
我们研究了6例患者（5 - 21天前体表烧伤面积达10 - 30%）在接受外科清创和植皮手术时阿芬太尼的处置情况，并将数据与6例年龄、性别和体重匹配、接受类似时长体表手术的对照组患者的数据进行了比较。静脉注射50微克/千克阿芬太尼后，在长达480分钟的时间内采集血浆样本。通过放射免疫分析法测定药物浓度，通过平衡透析法测定阿芬太尼与血浆蛋白的结合情况。烧伤患者的α1 - 酸性糖蛋白（AAG）浓度显著更高，白蛋白浓度更低。烧伤组阿芬太尼的平均蛋白结合率为94.2（标准误0.05）%，对照组为90.7（0.4）%（P = 0.004）。AAG浓度与蛋白结合之间存在良好的相关性（r = 0.8）。烧伤组阿芬太尼的分布容积和总清除率显著降低。阿芬太尼游离部分的清除率和消除半衰期没有显著降低。
