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[吸入麻醉药的药代动力学-药效学模型]

[Pharmacokinetic-pharmacodynamic models for inhaled anaesthetics].

作者信息

Kreuer S, Bruhn J, Wilhelm W, Bouillon T

机构信息

Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, 66421 Homburg/Saar.

出版信息

Anaesthesist. 2007 Jun;56(6):538-56. doi: 10.1007/s00101-007-1188-7.

Abstract

Pharmacokinetic models can be differentiated into two groups: physiological-based models and empirical models. Traditionally the pharmacokinetics of volatile anaesthetics are described using physiological-based models together with the respective tissue-blood distribution coefficients. The compartments of the empirical model have no anatomical equivalents and are merely the product of the mathematical procedure for parameter estimation. The end expiratory concentration of volatile anaesthetics is approximately equal to the arterial concentration and, therefore, the description of the transition between plasma and effect site for volatile anaesthetics plays a central role. The most important parameter here is the k(e0) value which is a time constant and describes the time delay for the transition from the central compartment to the calculated effect compartment. The k(e0) values for sevoflurane and isoflurane are the same but the concentration balance between the end-tidal concentration and the effect compartment occurs twice as quickly with desflurane. In clinical practice volatile anaesthetics are normally combined with N(2)O and/or opioids. This results in an additive interaction between volatile anaesthetics and N(2)O but a synergistic interaction of volatile anaesthetics with opioids. However, there are relatively few investigations on the interactions between the clinically widely used combination of volatile anaesthetics, N(2)O and opioids.

摘要

药代动力学模型可分为两类

基于生理学的模型和经验模型。传统上,挥发性麻醉药的药代动力学是使用基于生理学的模型以及各自的组织-血液分配系数来描述的。经验模型的房室没有解剖学上的对应物,仅仅是参数估计数学程序的产物。挥发性麻醉药的呼气末浓度大约等于动脉浓度,因此,描述挥发性麻醉药在血浆和效应部位之间的转变起着核心作用。这里最重要的参数是k(e0)值,它是一个时间常数,描述了从中央房室到计算出的效应房室转变的时间延迟。七氟烷和异氟烷的k(e0)值相同,但地氟烷的呼气末浓度与效应房室之间的浓度平衡速度快两倍。在临床实践中,挥发性麻醉药通常与N(2)O和/或阿片类药物联合使用。这导致挥发性麻醉药与N(2)O之间产生相加相互作用,但挥发性麻醉药与阿片类药物之间产生协同相互作用。然而,关于临床上广泛使用的挥发性麻醉药、N(2)O和阿片类药物组合之间相互作用的研究相对较少。

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