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地氟醚在平衡麻醉中药代动力学特征的研究 |
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叶铁虎 郭向阳 桑诺尔 罗爱伦 樊宏
摘要 目的：地氟醚在临床平衡麻醉中的效应及药代动力学特性。方法：以开放研究方式观察地氟醚用于40例ASAⅠ～Ⅱ级行腹部手术病人麻醉时的药代动力学特征。病人术前用药一致。麻醉维持中吸入1∶2的氧气/笑气+6%地氟醚，保持其肺泡浓度(FＡ)在3%(1个MAC)。同时静脉输入芬太尼2μg*kg－1*h－1，半小时后速度减半。间断给予阿曲库铵维持肌肉松弛。连续记录吸入浓度(FI)、肺泡浓度(FＡ)、设定浓度(FＤ)及终止麻醉时的肺泡浓度(FAO)。观察比值FＡ∶FＩ、FＡ∶FＤ、FＡ∶FAO达到1/2的时间及其在体内达到1个MAC值的平衡时间。结果：本研究中地氟醚的FＡ∶FＩ与FＡ∶FAO＝1/2的时间分别为1.6和2.0分钟，2.9分钟时体内浓度达到1个MAC值。停止麻醉后，平均6.5分钟后自主呼吸恢复。睁眼时间为8.6分钟。9分钟后拔管。具应答合作能力的时间是12分钟。结论：地氟醚的低溶解特性使其在体内的吸收与排出迅速，麻醉可控性增强。FＤ、FＡ与FＩ值迅速接近，提示地氟醚在低流量麻醉中更具有优势。
关键词 地氟醚 麻醉，全身 药代动力学
The profile of pharmacokinetics of desflurane during balance anesthesia for abdominal surgery patients Ye Tiehu，Guo Xiangyang，Sang Nuoer，et al．Department of Anesthesiology，Peking Union Medical College Hospital，Beijing 100730
Abstract Objective：This trial was designed to study the profile of the pharmacokinetics of desflurane in balance anesthesia．Method：Forty ASA physical status Ⅰ and Ⅱ patients undergoing abdominal surgery were admitted to this study．All patients were anesthetized with balance anesthesia technique，which received delivered concentration（FD）of 6％ desflurane in a fresh gas（O２∶N２O＝1∶2）inflow of 3L／min until end-tidal target concentration（FA）of 3％ desflurane was obtained，then the FD was adjusted to maintain the target concentration，30 min later the inflow was decreased to 1．5L／min．As well as nitrous oxide，oxygen and carbon dioxide concentrations were measured at the common gas outlet and the endotracheal tube connector respectively．At same time fentanyl and atracurium were given as necessary．The SpO２，BP，and HR were also measured．We observed the time of target concentration reached during wash-in period，and also the time of FA∶FAO＝1／2 during wash-out period at the end of operation．Result：During the first 30 min of 3L／min flow administration，the target concentration was obtained at 2．9 min，and was kept stable during the whole procedure，even during low flow（1．5L／min）it was not required to increase the FD to ma[1] [2] 下一页
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