老年人阿片类药物药代动力学的研究进展

Journal: Basic Medical Theory Research DOI: 10.32629/bmtr.v2i2.777

韩笑1, 张满和2, 宋阳1, 齐梦圆1

1. 华北理工大学
2. 唐山工人医院麻醉科

Abstract

随着生活水平和医疗水平的不断发展,国民预期寿命延长,慢性病死亡率降低,这种趋势使日常使用止痛药以对抗慢性疼痛的老年人增多,同时扩大了老年外科手术人口的比例[1]。众所周知老年人与青壮年相比拥有更为特殊的病理生理状态,这也导致临床上对于老年人的用药异常谨慎,所以研究老年人的药代动力学(PK)非常重要。而阿片类药物是常用的止痛药,也是全麻手术中必不可少的一部分,几十年来国内外的临床工作者为了实现老年患者的用药安全和剂量精准化,对阿片类药物的药代动力学进行了详尽的研究。衰老通过改变身体成分和器官功能影响阿片类药物的药代动力学[2],而各个因素所导致的药代学变化研究颇多结论却又不尽相同。本文旨在将近年来关于老年人阿片类药物药代动力学的研究进行总结和讨论,以期能够为后续的研究指明方向。

Keywords

阿片类药物;药代动力学;老年

References

[1] Sadean M R, Glass P S A. Pharmacokinetics in the elderly[J]. Best Practice & Research Clinical Anaesthesiology, 2003, 17(2): 191-205.
[2] Wilder-Smith, G. O H. Opioid use in the elderly[J]. European Journal of Pain, 2005, 9: 137-140.
[3] Henk Helmers M D, Achiel Van Peer P D, Woestenborghs R, et al. Alfentanil kinetics in the elderly[J]. Clin. Pharmacol. Ther., 1984, 36(2): 239-243.
[4] Scott J C, Stanski D A. Decreased Fentanyl and Alfentanil Dose Requirements with Age. A Simultaneous Pharmacokinetic and Pharmacodynamic
[5] Hudson R J, Thomson I R, Burgess P M, et al. Alfentanil pharmacokinetics in patients undergoing abdominal aortic surgery[J]. Canadian Journal of Anaesthesia, 1991, 38(1): 61-67.
[6] Helmers J H J H, Leeuwen L V, Zuurmond W W M. Sufentanil pharmacokinetics in young adult and elderly surgical patients[J]. Eur J Anaesthesiol, 1994, 11(3): 181-185.
[7] Yan Z, Xin-Min W U, Jing-Li D, et al. Pharmacokinetics of sufentanil administered by target-controlled infusion in Chinese surgical patients[J]. 中华医学杂志(英文版), 2009, 122(003): 291-295.
[8] Gupta D K, Avram M J. Rational Opioid Dosing in the Elderly: Dose and Dosing Interval When Initiating Opioid Therapy[J]. Clinical Pharmacology & Therapeutics, 2012, 91(2): 339-343.
[9] Whitener S, Mcevoy M D, Shafer S L, et al.: The Pharmacology of Intravenous Opioids, Geriatric Anesthesiology, 2018: 283-302.
[10] Chau D L, Walker V, Pai L, et al. Opiates and elderly: Use and side effects[J]. Clinical Interventions in Aging, 2008, 3.
[11] 周仁龙,王珊娟.老年人阿片类药物的药代动力学进展[J].《国外医学》麻醉学与复苏分册,2004,(25):39-41.
[12] Naples J G, Gellad W F, Hanlon J T. The Role of Opioid Analgesics in Geriatric Pain Management[J]. Clinics in Geriatric Medicine, 2016: S0749069016300519.
[13] Bjorkman S, Wada R D, Stanski D. Application of Physiologic Models to Predict the Influence of Changes in Body Composition and Blood Flows on the Pharmacokinetics of Fentanyl and Alfentanil in Patients[J]. Anesthesiology, 1998, 88(3): 657-667.
[14] Mullen E M, Granholm M. Drugs and the elderly patient[J]. Journal of Gerontological Nursing, 1981, 7(2): 108-113.
[15] Shi S, Klotz U. Age-Related Changes in Pharmacokinetics[J]. American Journal of Geriatric Pharmacotherapy, 2011, 12(7): -.
[16] Ehab S. Eldesoky M, Phd. Pharmacokinetic-Pharmacodynamic Crisis in the Elderly[J]. American Journal of Therapeutics, 2007,14: 488-498.
[17] Mercadante S. Opioid metabolism and clinical aspects[J]. European Journal of Pharmacology, 2015, 769: 71-78.
[18] Wynne H A, Mutch E, James O F W, et al. The effect of age upon the affinity of microsomal mono-oxygenase enzymes for substrate in human liver[J]. Age & Ageing, 1988, 17(6): 401-405.
[19] Lindeman R D, Tobin J, Shock N W. Longitudinal Studies on the Rate of Decline in Renal Function with Age[J]. Journal of the American Geriatrics Society, 1985, 33(4): 278-285.
[20] Baba Mika,Shimbo Takuro,Horio Masaru,Ando Masahiko,Yasuda Yoshinari,Komatsu Yasuhiro,Masuda Katsunori,Matsuo Seiichi,Maruyama Shoichi. Longitudinal Study of the Decline in Renal Function in Healthy Subjects.[J]. PloS one,2015,10(6).
[21] Mackenzie M, Zed P J, Ensom M H. Opioid Pharmacokinetics-
[22] Schlender J F, Meyer M, Thelen K, et al. Development of a Whole-Body Physiologically Based Pharmacokinetic Approach to Assess the Pharmacokinetics of Drugs in Elderly Individuals[J]. Clinical Pharmacokinetics, 2016, 55(12): 1573-1589.

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