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中华重症医学电子杂志 ›› 2018, Vol. 04 ›› Issue (01) : 18 -21. doi: 10.3877/cma.j.issn.2096-1537.2018.01.006

所属专题: 镇痛镇静 文献

综述

镇痛镇静药物在持续性肾脏替代治疗中的药代动力学
朱熠冰1, 席修明1,()   
  1. 1. 100038 北京,首都医科大学附属复兴医院重症医学科
  • 收稿日期:2017-07-17 出版日期:2018-02-01
  • 通信作者: 席修明

Pharmacokinetics of analgesics and sedatives in continuous renal replacement therapy

Yibing Zhu1, Xiuming Xi1,()   

  1. 1. Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing 100038, China
  • Received:2017-07-17 Published:2018-02-01
  • Corresponding author: Xiuming Xi
  • About author:
    Corresponding author:Xi Xiuming, E-mail:
引用本文:

朱熠冰, 席修明. 镇痛镇静药物在持续性肾脏替代治疗中的药代动力学[J/OL]. 中华重症医学电子杂志, 2018, 04(01): 18-21.

Yibing Zhu, Xiuming Xi. Pharmacokinetics of analgesics and sedatives in continuous renal replacement therapy[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2018, 04(01): 18-21.

重症疾病和持续性肾脏替代治疗(CRRT)都是影响镇痛镇静药物药代动力学的因素。重症疾病会影响药物吸收、组织穿透力、药物代谢、药物清除等药代动力学因素;CRRT对药代动力学的影响也体现在诸多方面,最主要的影响是药物清除。本文总结了重症患者常用镇痛镇静药物在CRRT治疗中的药代动力学及剂量调整建议。

Critical illness, acute kidney injury and continuous renal replacement therapy are contributing factors to pharmacokinetics in critically ill patients. We should take the pharmacokinetic factors into account in the treatment of critically ill patients. The pharmacokinetic factors include drug absorption, tissuepenetration, drug metabolism and clearance. This article concluded the pharmacokineticsof the most commonly used analgesics and sedatives for critically ill patients and recommended the dosage adjustment during CRRT.

表1 镇痛镇静药物的主要药代动力学参数[8]
[1]
Boucher BA, Wood GC, Swanson JM. Pharmacokinetic changes in critical illness [J]. Crit Care Clin, 2006, 22(2): 255-271.
[2]
Susla GM. The impact of continuous renal replacement therapy on drug therapy [J]. Clin Pharmacol Ther, 2009, 86(5): 562-565.
[3]
Vaara S, Pettila V, Kaukonen KM. Quality of pharmacokinetic studies in critically ill patients receiving continuous renal replacement therapy [J]. Acta Anaesthesiol Scand, 2012, 56(2): 147-157.
[4]
Nolin TD, Aronoff GR, Fissell WH, et al. Pharmacokinetic assessment in patients receiving continuous RRT: perspectives from the Kidney Health Initiative [J]. Clin J Am Soc Nephrol, 2015, 10(1): 159-164.
[5]
Schetz M. Drug dosing in continuous renal replacement therapy: general rules [J]. Curt Opin Crit Care, 2007, 13(6): 645-651.
[6]
Teraoka S, Mineshima M, Hoshino T, et al. Can cytokines be removed by hemofiltration or hemoadsorption [J]? ASAIO J, 2000, 46(4): 448-451.
[7]
Mitzner S, Klammt S, Stange J,et al. Albumin regeneration in liver support-comparison of different methods [J]. Ther Apher Dial, 2006, 10(2): 108-117.
[8]
Yogaratnam D, Ditch K, Medeiros K, et al. The Impact of Liver and Renal Dysfunction on the Pharmacokinetics and Pharmacodynamics of Sedative and Analgesic Drugs in Critically Ⅲ Adult Patients [J]. Crit Care Nurs Clin North Am, 2016, 28(2): 183-194.
[9]
Gepts E, Camu F, Cockshott ID, et al. Disposition of propofol administered as constant rate intravenous infusions in humans [J]. Anesth Analg, 1987, 66(12): 1256-1263.
[10]
Dawidowicz AL, Kalitynski R, Kobielski M, et al. Influence of propofol concentration in human plasma on free fraction of the drug [J]. Chem Biol Interact, 2006, 159(2): 149-155.
[11]
Takizawa D, Sato E, Hiraoka H, et al. Changes in apparent systemic clearance of propofol during transplantation of living related donor liver [J]. Br J Anaeth, 2005, 95(5): 643-647.
[12]
Dawidowicz AL, Fornal E, Mardarowicz M, et al. The role of human lungs in biotransformation of propofol [J]. Anesthesiology, 2000, 93(4): 992-997.
[13]
Shafer A, Doze VA, Shafer SL, et al. Pharmacokinetics and pharmacodynamics of propofol infusions during general anesthesia [J]. Anesthesiology, 1988, 69(3): 348-356.
[14]
Schüttler J, Ihmsen H. Population pharmacokinetics of propofol: a multicenter study [J]. Anesthesiology, 2000, 92(3): 727-738.
[15]
Kataria BK, Ved SA, Nicodemus HF, et al. The pharmacokinetics of propofol in children using three different data analysis approaches [J]. Anesthesiology, 1994, 80(1): 104-122.
[16]
Johnson KB, Egan TD, Kern SE, et al. The influence of hemorrhagic shock on propofol: a pharmacokinetic and pharmacodynamic analysis [J]. Anesthesiology, 2003, 99(2): 409-420.
[17]
Amrein R, Hetzel W. Pharmacology of Dormicum (midazolam) and Anexate (flumazenil) [J]. Acta Anaesthesiol Scand Suppl, 1990, 92: 6-15.
[18]
Panzer O, Moitra V, Sladen RN. Pharmacology of sedative-analgesic agents: dexmedetomidine, remifentanil, ketamine, volatile anesthetics, and the role of peripheral Mu antagonists [J]. Anesthesiol Clin, 2011, 29(4): 587-605.
[19]
Vincent JL, Shehabi Y, Walsh TS, et al. Comfort and patient-centred care without excessive sedation: the eCASH concept [J]. Intensive Care Med, 2016, 42(6): 962-971.
[20]
Yapici N, Coruh T, Kehlibar T, et al. Dexmedetomidine in cardiac surgery patients who fail extubation and present with a delirium state [J]. Heart Surg Forum, 2011, 14(2): E93- E98.
[21]
Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit [J]. Crit Care Med, 2013, 41(1): 263-306.
[22]
Murphy EJ. Acute pain management pharmacology for the patient with concurrent renal or hepatic disease [J]. Anaesth Intensive Care, 2005, 33(3): 311-322.
[23]
Zöllner C, Schäfer M. Opioids in anesthesia [J]. Anaesthesist, 2008, 57(7): 729-740.
[24]
Fyman PN, ReynoldsJR, MoserF, et al. Pharmacokinetics of sufentanil in patients undergoing renal transplantation [J]. Can J Anaesth, 1988, 35(3(Pt 1)): 312-315.
[25]
Sztark F, Lagneau F. Agents for sedation and analgesia in the intensive care unit [J]. Ann Fr Anesth Reanim, 2008, 27(7-8): 560-566.
[26]
Stroumpos C, Manolaraki M, Paspatis GA. Remifentanil, a different opioid: potential clinical applications and safety aspects [J]. Expert Opin Drug Saf, 2010, 9(2): 355-364.
[27]
Mazoit JX, Butscher K, Samii K. Morphine in postoperative patients: pharmacokinetics and pharmacodynamics of metabolites [J]. AnesthAnalg, 2007, 105(1): 70-78.
[28]
Power BM, Forbes AM, van Heerden PV, et al. Pharmacokinetics of drugs used in critically ill adults [J]. Clin Pharmacokinet, 1998, 34(1): 25-56.
[29]
Verbeeck RK, Musuamba FT. Pharmacokinetics and dosage adjustment in patients with renal dysfunction [J] .Eur J ClinPharmacol, 2009, 65(8): 757-773.
[30]
Yogaratnam D, Miller MA, Smith BS. The effects of liver and renal dysfunction on the pharmacokinetics of sedatives and analgesics in the critically ill patient [J]. Crit Care Nurs Clin North Am, 2005, 17(3): 245-250.
[31]
Yogaratnam D, Ditch K, Medeiros K, et al. The Impact of Liver and Renal Dysfunction on the Pharmacokinetics and Pharmacodynamics of Sedative and Analgesic Drugs in Critically Ill Adult Patients [J]. Crit Care Nurs Clin North Am, 2016, 28(2): 183-194.
[32]
Bolon M, Bastien O, Flamens C, et al. Midazolam disposition in patients undergoing continuous venovenous hemodialysis [J]. J Clin Pharmacol, 2001, 41(9): 959-962.
[33]
Lam SW, Alexander E. Dexmedetomidine use in critical care [J]. AACN Adv Crit Care, 2008, 19(2):113-120.
[34]
Wagner BK, O′Hara DA. Pharmacokinetics and pharmacodynamics of sedatives and analgesics in the treatment of agitated critically ill patients [J]. Clin Pharmacokinet, 1997, 33(6): 426-453.
[35]
Wilhelm W, Kreuer S. The place for short-acting opioids: special emphasis on remifentanil [J]. Crit Care, 2008, 12(3 Suppl): S5.
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