Résumé
ObjectiveTo study the pharmacokinetics of sufentanil in patients undergoing different cardiac surgeries with or without CPB.MethodsSixteen ASA Ⅱ or Ⅲ patients aged 56-64 yr weighing 52-78 kg undergoing cardiac surgery were divided into 2 groups ( n ＝ 8 each):group Ⅰ off-pump coronary artery bypass grafting and group Ⅱ valve replacement.Radial artery and peripheral vein were cannnlated.A bolus of sufentanil 5μg/kg was administered iv after induction of anesthesia.Blood samples were obtained from radial artery at 1,3,5,10,20,30,60,120,180,240,360 min after sufentanil injection.Plasma was immediately separated and stored at - 80 C for determination of plasma sufentanil concentration by liquid c hromatography-mass spectrometry.Pharmacokinetic parameters were calculated by 3P97 pharmacological program.ResultsThe pharmacokinetic profile of sufentanil was best described by a three-compartment open model.The 3 exponential equations in group Ⅰ,before and during CPB in group Ⅱ were:Cp(t) ＝ 11.7 e-0.47t + 1.9 e0.043t + 0.27 e-0.0032t ; Cp(t) ＝ 33.4 e-1.87t + 7.1e-0.103t +2.0 e-0.0248t and Cp(t) ＝ 23.8 e-0.54t + 5.2 e0.054t + 0.15 e-0.0017t respectively.There was significant difference in most of the pharmacokinetic parameters between the 2 groups.ConclusionsThe pharmacokinetics of sufentanil in patients undergoing different cardiac surgeries can be described by ~compartment open model.Low cardiac function and CPB can reduce its drug metabolism rate and prolong the duration of action.
Résumé
ObjectiveTo sum up the experience in the treatment of acute arterial ischemia in the extremities. Methods From 1980 to 2001,148 patients with acute arterial ischemia in the extremities were treated by multiple-means such as: embolectomy, interventional treatment, thrombolytic and antiagglutinatives. Results The cure rate in patients treated within 12 hours was 95.5%,mortality was 4.5%,while the cure rate, alleviative rate, amputation rate and mortality in patients treated 12～24 hours after onset were 64.8%,17.6%,9.9%,7.7%,respectively and that were 20%,34.3%,25.7%,20% respectively when treatment started 24 hours after the onset. The cure rate in 19 patients treated by nonoperative means was 10.5%, alleviative rate was 73.3%, amputation rate was 15.8%. Conclusion Patients with acute arterial ischemia suffer a high mortality. Mortality and disability rate can be reduced by early diagnosis, appropriate treatment and effective management for the systemic diseases.