患者自控镇痛后吗啡及其代谢物：对呼吸抑制的考虑。

Morphine and its metabolites after patient-controlled analgesia: considerations for respiratory depression.

机构信息

Department of Anesthesia, Stanford University, H3580, 300 Pasteur Dr, Stanford, CA 94305-5640, USA.

出版信息

J Clin Anesth. 2011 Mar;23(2):102-6. doi: 10.1016/j.jclinane.2010.08.002.

DOI:10.1016/j.jclinane.2010.08.002

PMID:21377072

Abstract

STUDY OBJECTIVE

To assess concentrations of morphine and its metabolites after patient-controlled analgesia (PCA).

DESIGN

Pilot pharmacokinetic study of morphine and pharmacokinetic simulation.

SETTING

Post-anesthesia care room and ward of an academic teaching hospital.

PATIENTS

10 ASA physical status I, II, and III postoperative surgical patients.

INTERVENTIONS

Patients received morphine via PCA by routine hospital protocols.

MEASUREMENTS

The population mean plasma and effect-site concentrations of morphine, morphine-6-glucuronide (M6G), and morphine-3-glucuronide (M3G) was simulated in 4 patient group scenarios: morphine PCA used alone, morphine PCA used with continuous background morphine infusion of 0.5 mg/hr, morphine PCA used with continuous background morphine infusion of 1.0 mg/hr, and morphine PCA used with continuous background morphine infusion of 2.0 mg/hr.

MAIN RESULTS

The 4 groups exhibited simulated peak morphine, M6G, and M3G effect-site concentrations at 8 to 24 hours post-infusion. The highest peak morphine, M6G, and M3G effect-site concentrations decreased in the following order by group: 2.0 mg/hr morphine infusion + PCA group, 1.0 mg/hr morphine infusion + PCA group, and 0.5. mg/hr morphine infusion + PCA group.

CONCLUSIONS

Patients receiving morphine PCA should be monitored closely from 8 to 24 hours postoperatively. Morphine PCA given with background infusion rates up to 1.0 mg/hr does not offer distinct pharmacokinetic advantages over morphine PCA alone. Morphine PCA with background infusion rate of 2.0 mg/hr is associated with the greatest risk of respiratory depression.

摘要

研究目的

评估患者自控镇痛（PCA）后吗啡及其代谢物的浓度。

设计

吗啡药代动力学的初步研究和药代动力学模拟。

地点

学术教学医院的麻醉后护理室和病房。

患者

10 名 ASA 体格 I、II 和 III 级术后外科患者。

干预

患者根据医院常规方案接受 PCA 吗啡治疗。

测量

在 4 个患者组场景中模拟群体平均血浆和效应部位的吗啡、吗啡-6-葡萄糖苷酸（M6G）和吗啡-3-葡萄糖苷酸（M3G）浓度：单独使用吗啡 PCA、吗啡 PCA 与 0.5mg/hr 的持续背景吗啡输注、吗啡 PCA 与 1.0mg/hr 的持续背景吗啡输注和吗啡 PCA 与 2.0mg/hr 的持续背景吗啡输注。