曲马多术后持续静脉镇痛的药效学及其血清浓度监测(3)
曲马多术后持续静输的血清浓度存在较大差异。Jellinek等[3]报道，在20例妇科手术后病人中，应用曲马多持续静输镇痛24h，负荷剂量为3mg/kg，然后予维持剂量0.35mg·kg-1·h-1，其平均血清曲马多浓度为(1.170±0.357)μg/ml。Lehmann等[6]报道曲马多用于术后病人自控镇痛(PCA)的最低有效浓度为0.289μg/ml。作者测得曲马多术后镇痛的平均最低有效浓度为0.370μg/ml[7]。曲马多连续静输用于术后镇痛的治疗浓度究竟在何范围才能达到满意的镇痛效果，难以定论。但从本文结果分析，曲马多血清治疗浓度高于其最低治疗浓度的30%左右，也即在500ng/ml以上，基本能获得满意的镇痛效应。另本文观察到曲马多连续静输40h后，其血清浓度渐上升，是否提示该药有蓄积作用有待进一步研究。另外与曲马多的代谢产物(本研究未测)可能也有关系。
参考文献
1 Yeh Gc, Sheu MT, Yen CL, et al. High-performance liquid chromtographic method for determination of tramadol in human plasma. J Chromatogr B Biomed Sci Appl, 1999, 723:247-253.
2 Budd K. Chronic pain: challenge and response. Drugs, 1994, 47:33-36.
3 Sunshine A. New clinical experience with tramadol. Drugs, 1994, 47:8-18.
4 Pang WW, Mok MS, Lin CH, et al. Comparison of patient-controlled analgesia (PCA) with tramadol or morphine. Can J Anaesth, 1999, 46:1030-1035.
5 Bamigbade TA, Langford RM. The clinical use of tramadol hydrochloride. Pain Rev, 1998, 5:155-182.
6 Lehmann KA. Patient-controlled intravenous analgesia for postoperative pain relief. Adv Pain Res Ther, 1991, 18:481-506.
7 徐惠芳,朱永满,江伟.曲马多用于术后静脉镇痛时的血清治疗浓度.中华麻醉学杂志,2001,21:207-209
HYS-MD-WM
2002-10-11, http://www.100md.com(江伟 朱永满 徐惠芳)
参考文献
1 Yeh Gc, Sheu MT, Yen CL, et al. High-performance liquid chromtographic method for determination of tramadol in human plasma. J Chromatogr B Biomed Sci Appl, 1999, 723:247-253.
2 Budd K. Chronic pain: challenge and response. Drugs, 1994, 47:33-36.
3 Sunshine A. New clinical experience with tramadol. Drugs, 1994, 47:8-18.
4 Pang WW, Mok MS, Lin CH, et al. Comparison of patient-controlled analgesia (PCA) with tramadol or morphine. Can J Anaesth, 1999, 46:1030-1035.
5 Bamigbade TA, Langford RM. The clinical use of tramadol hydrochloride. Pain Rev, 1998, 5:155-182.
6 Lehmann KA. Patient-controlled intravenous analgesia for postoperative pain relief. Adv Pain Res Ther, 1991, 18:481-506.
7 徐惠芳,朱永满,江伟.曲马多用于术后静脉镇痛时的血清治疗浓度.中华麻醉学杂志,2001,21:207-209
HYS-MD-WM
2002-10-11, http://www.100md.com(江伟 朱永满 徐惠芳)