Miller R S, Peterson G M, McLean S, Möller C
Tasmanian School of Pharmacy, Faculty of Medicine and Pharmacy, University of Tasmania, Hobart, Australia.
J Clin Pharm Ther. 1997 Jun;22(3):197-205. doi: 10.1046/j.1365-2710.1997.94875948.x.
This study was conducted to examine the effect of cardiopulmonary bypass surgery on the total and unbound plasma concentrations of fentanyl and the total plasma concentrations of alcuronium. Total fentanyl concentrations were measured by gas chromatography, the plasma protein binding of fentanyl by ultrafiltration, and alcuronium concentrations by high-performance liquid chromatography. Sixteen patients were studied. On initiation of cardiopulmonary bypass (CPB), there were mean decreases of 58.8 +/- 7.1% and 47 +/- 3.2% for total concentrations of fentanyl in plasma and haemoglobin in blood, respectively. The magnitude of these reductions in individual patients was significantly related (Spearman p = 0.65, P < 0.05). The unbound fraction of fentanyl rose from 0.23 to 0.34 after the start of CPB. The total fentanyl concentration remained relatively stable during bypass until near the end of CPB when the mean total concentration increased, coinciding with rewarming. The size of the increase was related to the body mass index (BMI) of the patient (Spearman p = 0.85, P < 0.01). The estimated elimination half-life of fentanyl using the grouped data was 4.7 h. The total alcuronium concentration in plasma fell by 29% on initiation of CPB and there was no increase on rewarming. The estimated elimination half-life of alcuronium using the grouped data was 234 min. Despite marked declines in the plasma concentrations of both drugs on initiation of CPB, suitable levels of anaesthesia were maintained throughout the procedure.
本研究旨在探讨体外循环手术对芬太尼血浆总浓度及游离浓度，以及阿库氯铵血浆总浓度的影响。采用气相色谱法测定芬太尼总浓度，超滤法测定芬太尼血浆蛋白结合率，高效液相色谱法测定阿库氯铵浓度。研究了16例患者。在开始体外循环（CPB）时，血浆中芬太尼总浓度和血液中血红蛋白分别平均下降58.8±7.1%和47±3.2%。这些个体患者中下降幅度具有显著相关性（Spearman p = 0.65，P < 0.05）。CPB开始后，芬太尼的游离分数从0.23升至0.34。在体外循环期间，芬太尼总浓度保持相对稳定，直到CPB接近结束时平均总浓度增加，这与复温同时发生。增加的幅度与患者的体重指数（BMI）相关（Spearman p = 0.85，P < 0.01）。使用分组数据估计的芬太尼消除半衰期为4.7小时。CPB开始时，血浆中阿库氯铵总浓度下降29%，复温时无增加。使用分组数据估计的阿库氯铵消除半衰期为234分钟。尽管CPB开始时两种药物的血浆浓度均显著下降，但在整个手术过程中仍维持了合适的麻醉水平。
