Davis P J, Stiller R L, Cook D R, Brandom B W, Davis J E, Scierka A M
Department of Anesthesiology, Children's Hospital of Pittsburgh, PA 15213-2583.
Anesth Analg. 1989 May;68(5):579-83.
The role of the liver and the kidney in alfentanil metabolism has not been defined. The effects of cholestatic hepatic disease and chronic renal failure on the pharmacokinetics of alfentanil were evaluated in 9 children undergoing liver transplantation and 10 children undergoing kidney transplantation. These findings were compared with data from 10 children with normal hepatic and renal function undergoing other surgical procedures. There was no statistical difference among the 3 groups with respect to apparent volume of distribution, half-life, or clearance. In a subgroup of 3 patients undergoing liver transplantation alfentanil kinetics were determined both before and after the allograft was incorporated into the recipient's circulation. Though both volume of distribution and elimination half-life increased in the posttransplantation period, only the decrease in clearance was statistically significant. Thus, it appears that alfentanil may be a useful anesthetic agent in pediatric patients with cholestatic hepatic disease or chronic renal failure. The dose of alfentanil in these patients need not be altered except in the period immediately after liver transplantation.
肝脏和肾脏在阿芬太尼代谢中的作用尚未明确。对9例接受肝移植的儿童和10例接受肾移植的儿童，评估了胆汁淤积性肝病和慢性肾衰竭对阿芬太尼药代动力学的影响。将这些结果与10例肝肾功能正常、接受其他外科手术的儿童的数据进行比较。三组在分布容积、半衰期或清除率方面无统计学差异。在3例接受肝移植的患者亚组中，在同种异体移植物接入受者循环前后均测定了阿芬太尼动力学。虽然移植后分布容积和消除半衰期均增加，但只有清除率的降低具有统计学意义。因此，阿芬太尼似乎可能是胆汁淤积性肝病或慢性肾衰竭小儿患者的一种有用麻醉剂。这些患者的阿芬太尼剂量除肝移植后即刻外无需改变。
