Department of Anesthesia, Stanford University, H3580, 300 Pasteur Dr, Stanford, CA 94305-5640, USA.
J Clin Anesth. 2011 Mar;23(2):102-6. doi: 10.1016/j.jclinane.2010.08.002.
To assess concentrations of morphine and its metabolites after patient-controlled analgesia (PCA).
Pilot pharmacokinetic study of morphine and pharmacokinetic simulation.
Post-anesthesia care room and ward of an academic teaching hospital.
10 ASA physical status I, II, and III postoperative surgical patients.
Patients received morphine via PCA by routine hospital protocols.
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.
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.
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.
评估患者自控镇痛（PCA）后吗啡及其代谢物的浓度。
吗啡药代动力学的初步研究和药代动力学模拟。
学术教学医院的麻醉后护理室和病房。
10 名 ASA 体格 I、II 和 III 级术后外科患者。
患者根据医院常规方案接受 PCA 吗啡治疗。
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。
4 组在输注后 8 至 24 小时表现出模拟的吗啡、M6G 和 M3G 效应部位的峰值浓度。最高的吗啡、M6G 和 M3G 效应部位峰值浓度按组递减：2.0mg/hr 吗啡输注+PCA 组、1.0mg/hr 吗啡输注+PCA 组和 0.5mg/hr 吗啡输注+PCA 组。
接受吗啡 PCA 的患者应在术后 8 至 24 小时内密切监测。与单独使用吗啡 PCA 相比，背景输注率高达 1.0mg/hr 的吗啡 PCA 并未提供明显的药代动力学优势。背景输注率为 2.0mg/hr 的吗啡 PCA 与呼吸抑制的风险最大相关。
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