Lehmann K A, Ribbert N, Horrichs-Haermeyer G
J Pain Symptom Manage. 1990 Aug;5(4):249-58. doi: 10.1016/0885-3924(90)90019-g.
Forty ASA I-III patients recovering from major abdominal or orthopedic operations were investigated in an open clinical study to evaluate analgesic efficacy and threshold plasma concentrations of alfentanil during the early postoperative period using patient-controlled analgesia (PCA) by means of the On-Demand Analgesia Computer. Alfentanil demand dose was 212 micrograms, continuous infusion rate 25 micrograms/hr, hourly maximum dose 1.5 mg/hr; the lockout time was set to 1 min. The duration of PCA was 18.1 +/- 5.2 hr (mean, SD) during which time 23.8 +/- 14.2 demands per patient were recorded, resulting in an average alfentanil consumption of 4.99 +/- 3.03 micrograms/kg/hr. Patient acceptance of PCA was high. Side effects were only of minor intensity and never gave rise to concern. Based on our own earlier PCA experience with other opiate analgesics, alfentanil proved to be about 1/15th as potent an analgesic as fentanyl and about 6-7 times more potent than morphine if both intensity and duration of effect were considered. Minimum effective alfentanil plasma concentration (MEC) varied greatly and could be best described by a lognormal distribution (range 0.6-99.2 ng/mL, median 14.9 ng/mL). Intraindividual MEC variability was consistently lower than intersubject variability (37.0% vs 65.2%).
在一项开放性临床研究中，对40例接受腹部大手术或骨科手术且术后正在恢复的美国麻醉医师协会（ASA）分级为I - III级的患者进行了调查，目的是通过按需镇痛计算机采用患者自控镇痛（PCA）来评估术后早期阿芬太尼的镇痛效果和血浆阈值浓度。阿芬太尼按需剂量为212微克，持续输注速率为25微克/小时，每小时最大剂量为1.5毫克/小时；锁定时间设定为1分钟。PCA持续时间为18.1±5.2小时（均值，标准差），在此期间记录到每位患者平均有23.8±14.2次按需给药，阿芬太尼平均消耗量为4.99±3.03微克/千克/小时。患者对PCA的接受度很高。副作用仅为轻度，从未引起担忧。根据我们之前使用其他阿片类镇痛药进行PCA的经验，如果同时考虑作用强度和持续时间，阿芬太尼的镇痛效力约为芬太尼的1/15，约为吗啡的6 - 7倍。阿芬太尼的最低有效血浆浓度（MEC）差异很大，最好用对数正态分布来描述（范围为0.6 - 99.2纳克/毫升，中位数为14.9纳克/毫升）。个体内MEC变异性始终低于个体间变异性（37.0%对65.2%）。
