肥胖患者的阿芬太尼药代动力学研究进展
Journal: Basic Medical Theory Research DOI: 10.32629/bmtr.v2i3.1676
Abstract
随着世界经济的高速发展和饮食文化的高度互融,肥胖人群数量大幅度增多,就目前的趋势持续下去,到2030年,世界上将多达58%的成年人超重[1]。而肥胖所带来的身体结构的改变不仅会在接受手术麻醉时增加解剖方面的难度,还会引起重要的生理方面的变化,并潜在的影响麻醉药物的药代动力学和药效学,为麻醉医生带来挑战。阿芬太尼作为一种合成阿片类药物,其药代动力学数据大部分来自于正常体重的患者,国内外仅有少数研究对肥胖患者阿芬太尼的药代动力学和药效学进行了评价,因此尚需进一步研究。
Keywords
阿芬太尼；肥胖；药代动力学
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[2] Kopelman PG. Obesity as a medicalproblem[J].Nature,2000,404(6778):635-643.
[3] Pösö T, Kesek D, Winsö O, et al.Volatile rapid sequence induction inmorbidly obese patients[J].EurJAnaesthesiol,2011,28(11):781-787.
[4] Duflou J, Virmani R, Rabin I, etal. Sudden death as a result of heartdisease in morbid obesity[J].Am HeartJ,1995,130(2):306-313.
[5] Garfinkel L.Overweight and cancer[J].Ann Intern Med, 1985,103(6_Part_2):1034-1036.
[6] Georges C. Effects of obesityon pharmacokinetics. Implications fordrug therapy[J].Clin Pharmacokinet,2000,39(215):31.
[7] Cheymol G. Clinical pharmacokineticsof drugs in obesity[J].Clin Pharmacokinet,1993,25(2):103-114.
[8] Adams JP, Murphy PG. Obesity inanaesthesia and intensive care[J]. Br JAnaesth,2000,85(1):91-108.
[9] Abernethy DR, Greenblatt DJ.Drug disposition in obese humans[J].ClinPharmacokinet,1986,11(3):199-213.
[10] Casati A, Putzu M. Anesthesiain the obese patient: pharmacokineticconsiderations[J]. J Clin Anesth, 2005,17(2):134-145.
[11] De Baerdemaeker LEC, MortierEP, Struys MMRF. Pharmacokinetics inobese patients[J]. Continuing Educationin Anaesth. Crit. Care Pain Med, 2004,4(5):152-155.
[12] Hanley MJ, Abernethy DR,Greenblatt DJ. Effect of obesity on thepharmacokinetics of drugs in humans[J].Clin Pharmacokinet,2010,49(2):71-87.
[13] Bolinder J,Kerckhoffs DA, MobergE, et al. Rates of skeletal muscle andadipose tissue glycerol release innonobese and obese subjects[J].Diabetes,2000,9(5):797-802.
[14] 刘晓璐,陆军,李雪娇,等.肥胖患者体内药代动力学变化及给药方案制定[J].实用药物与临床,2015,18(12):1508-1512.
[15] Wasan KM, Lopez-Berestein G.The influence of serum lipoproteins onthe pharmacokinetics and pharmacodynamicsof lipophilic drugs and drug carriers[J].Arch.Med.Res,1993,24(4):395-401.
[16] Barbeau P, Litaker MS, WoodsKF, et al. Hemostatic and inflammatorymarkers in obese youths: effects ofexercise and adiposity[J]. J Pediatr,2002,141(3):415-420.
[17] Derry CL, Kroboth PD, PittengerAL, et al. Pharmacokinetics andpharmacodynamics of triazolam aftertwo intermittent doses in obese andnormal-weight men[J].J ClinPsychopharmacol,1995,15(3):197-205.
[18] Guzzaloni G, Grugni G, MinocciA, et al. Liver steatosis in juvenileobesity:correlations with lipid profile,hepatic biochemical parameters andglycemic and insulinemic responses toan oral glucose tolerance test[J].Int JObes,2000,24(6):772-776.
[19] Ratziu V, Giral P, Charlotte F,et al. Liver fibrosis in overweightpatients[J].Gastroenterology,2000,118(6):1117-1123.
[20] Stanski DR, Hug CC. Alfentanil—a kinetically predictable narcoticanalgesic[J].Anesthesiology:TheJournal of the American Society of Anesthesiologists,1982,57(6):435-438.
[21] Ijaz S, Yang W, Winslet MC, etal. Impairment of hepatic microcirculationin fatty liver[J]. Microcirculation,2003,10(6):447-456.
[22] Young JF, Luecke RH, Pearce BA,et al.Human organ/tissue growth algorithmsthat include obese individuals andblack/white population organ weightsimilarities from autopsy data[J].JToxicol Environ Health,Part A,2009,72(8):527-540.
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[24] Han PY, Duffull SB, KirkpatrickCMJ, et al. Dosing in obesity: a simplesolution to a big problem[J].ClinPharmacol Ther,2007,82(5):505-508.
[25] Avram MJ, Krejcie TC. Usingfront-end kinetics to optimize target-controlled drug infusions[J]. Anesthesiology,2003,99(5):1078-1086.
[26] Michiels M,Hendriks R, HeykantsJ.Radioimmunoassay of the new opiateanalgesics alfentanil and sufentanil.Preliminary pharmacokinetic profile inman[J]. J Pharm Pharmacol,1983,35(2):86-93.
[27] Bovill JG, Sebel PS, BlackburnCL, et al. The pharmacokinetics ofalfentanil (R39209):a new opioid analgesic[J].Anesthesiology,1982,57(6):439-443.
[28] Scott JC, Ponganis KV, StanskiDR.EEG Quantitation of Narcotic EffectTheComparative Pharmacodynamics of Fentanyland Alfentanil[J].Anesthesiology,1985,62(3):234-241.
[29] Ogunnaike BO, Jones SB, JonesDB, et al. Anesthetic considerationsfor bariatric surgery[J]. Anesth Analg,2002,95(6):1793-1805.
[30] 崔亚军,焦涛.腹腔镜胆囊切除术中瑞芬太尼与阿芬太尼的全身麻醉效果比较[J].吉林医学,2018,39(3):420-422.
[31] Schwartz AE, Matteo RS, OrnsteinE, et al. Pharmacokinetics of sufentanilin obese patients[J].Anesth Analg,1991,73(6):90-793.
[32] La Colla L, Albertin A, La CollaG, et al. Predictive performance of the‘Minto’remifentanil pharmacokineticparameter set in morbidly obesepatients ensuing from a new method forcalculating lean body mass[J].ClinPharmacokinet,2010,49(2):131-139.
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