肝硬化患者的硫喷妥钠药代动力学
Thiopental pharmacokinetics in patients with cirrhosis.
作者信息
Pandele G, Chaux F, Salvadori C, Farinotti M, Duvaldestin P
出版信息
Anesthesiology. 1983 Aug;59(2):123-6. doi: 10.1097/00000542-198308000-00010.
The effect of cirrhosis on the pharmacokinetics and plasma protein binding of thiopental was studied in eight patients with cirrhosis, aged (mean +/- SD) 42 +/- 11 yr, and nine patients with normal hepatic and renal function, aged 48 +/- 12 yr, undergoing elective abdominal or orthopedic surgery. The total apparent volume of distribution at steady state was of 2.3 +/- 0.5 1 X kg-1 in the controls and of 3.5 +/- 1.9 1 X kg-1 in the patients with cirrhosis. Thiopental plasma clearance based upon total drug concentrations was 3.9 +/- 1.2 ml X min-1 X kg-1 in the normal group and did not differ significantly in the patients with cirrhosis: 4.4 +/- 2.2 ml X min-1 X kg-1. The elimination half-life was of 529 +/- 97 min in the controls and of 714 +/- 252 min in the patients with cirrhosis. The thiopental free fraction was 14.5 +/- 3.4% in the controls and was increased significantly to 25.2 +/- 3.9% in the patients with cirrhosis. Thiopental intrinsic clearance was decreased insignificantly (P = 0.06) from 28.3 +/- 9.0 ml X min-1 X kg-1 in the controls to 18.2 +/- 10.5 ml X min-1 X kg-1 in those with cirrhosis, suggesting that these patients may have a decreased capacity for thiopental metabolism. These results suggest that the risk of a prolonged effect following thiopental administration appears unlikely in patients with cirrhosis.
研究了肝硬化对硫喷妥药代动力学及血浆蛋白结合率的影响。研究对象为8例肝硬化患者（年龄[均值±标准差]为42±11岁）和9例肝肾功能正常患者（年龄48±12岁），这些患者均接受择期腹部或骨科手术。对照组稳态时的总表观分布容积为2.3±0.5 L·kg⁻¹，肝硬化患者为3.5±1.9 L·kg⁻¹。基于总药物浓度计算的硫喷妥血浆清除率，正常组为3.9±1.2 ml·min⁻¹·kg⁻¹，肝硬化患者与之无显著差异：4.4±2.2 ml·min⁻¹·kg⁻¹。对照组的消除半衰期为529±97分钟，肝硬化患者为714±252分钟。硫喷妥的游离分数在对照组为14.5±3.4%，在肝硬化患者中显著升高至25.2±3.9%。硫喷妥的内在清除率从对照组的28.3±9.0 ml·min⁻¹·kg⁻¹降至肝硬化患者的18.2±10.5 ml·min⁻¹·kg⁻¹，但差异不显著（P = 0.06），提示这些患者硫喷妥代谢能力可能下降。这些结果表明，肝硬化患者使用硫喷妥后出现作用延长的风险似乎不大。
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