Kennedy J M, van Rij A M
School of Pharmacy, University of Otago, Dunedin, New Zealand.
Br J Anaesth. 2006 Aug;97(2):171-80. doi: 10.1093/bja/ael117. Epub 2006 May 26.
The effects of surgery on gastric emptying have been documented for a considerable time, but less is known about the effects in the small intestine. It is thought that there is minimal diminution in the absorptive capacity of the small intestine after operation, although there is no literature on drug absorption in the early period after surgery. This study investigated drug absorption from the small bowel in patients undergoing abdominal surgery.
A prospective study of patients undergoing major abdominal surgery in which patients acted as their own preoperative controls was carried out. Patients were administered the test substances, acetaminophen and (99m)TcDTPA, before operation and 2 days after operation. Small intestine transit times, plasma concentrations and other pharmacokinetic variables were compared using Student's paired t-test. Two complementary studies were carried out to establish pharmacokinetic parameters.
There were no significant differences in the pre- and postoperative values of t(max), area under the curve, and area under the moment curve (AUMC) before and after operation (P>0.05). There were significant differences between the pre- and postoperative values of C(max) [C(max (preop))>C(max (postop)); P<0.05] and the pre- and postoperative values of mean residence time (MRT) [MRT((preop))<MRT((postop)); P<0.01].
Drug absorption from the small bowel in the postoperative patient does not differ significantly from its preoperative absorptive capacity.
手术对胃排空的影响已有相当长的时间被记录，但对小肠的影响了解较少。尽管术后早期药物吸收方面尚无文献报道，但人们认为术后小肠的吸收能力仅有轻微下降。本研究调查了接受腹部手术患者小肠的药物吸收情况。
对接受大型腹部手术的患者进行前瞻性研究，患者以自身术前情况作为对照。患者在手术前和手术后2天分别给予测试物质对乙酰氨基酚和（99m）锝-二乙三胺五乙酸（TcDTPA）。使用学生配对t检验比较小肠转运时间、血浆浓度和其他药代动力学变量。进行了两项补充研究以确定药代动力学参数。
手术前后tmax、曲线下面积和矩曲线下面积（AUMC）的术前和术后值无显著差异（P>0.05）。Cmax的术前和术后值[Cmax（术前）>Cmax（术后）；P<0.05]以及平均驻留时间（MRT）的术前和术后值[MRT（术前）<MRT（术后）；P<0.01]存在显著差异。
术后患者小肠的药物吸收与其术前吸收能力无显著差异。
