Hannam J A, Anderson B J
Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Anaesth Intensive Care. 2012 Sep;40(5):867-70. doi: 10.1177/0310057X1204000516.
A morphine plasma concentration/respiratory rate relationship has been described for both adults and children although that of its metabolite, morphine-6-glucuronide, remains uncertain. We describe this relationship in a child with end-stage renal failure who received repeat morphine administration over two days. An EMAX model for additive morphine and morphine-6-glucuronide respiratory effects described respiratory rate better than models describing either alone. Failure to clear morphine-6-glucuronide renally led to respiratory depression episodes occurring later than those predicted by modelling morphine levels only. These findings support the use of alternative analgesics (e.g. fentanyl) that are cleared by non-renal pathways and have no active metabolites in patients with end-stage renal disease.
虽然已经描述了成人和儿童的吗啡血浆浓度/呼吸频率关系，但其代谢产物吗啡-6-葡萄糖醛酸苷的关系仍不确定。我们描述了一名终末期肾衰竭儿童在两天内反复使用吗啡后的这种关系。一个用于叠加吗啡和吗啡-6-葡萄糖醛酸苷呼吸效应的EMAX模型比单独描述两者的模型能更好地描述呼吸频率。肾脏无法清除吗啡-6-葡萄糖醛酸苷导致呼吸抑制发作比仅根据吗啡水平建模预测的时间更晚。这些发现支持在终末期肾病患者中使用通过非肾脏途径清除且无活性代谢产物的替代镇痛药（如芬太尼）。
