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Population-based volume kinetics of Ringer's lactate solution in patients undergoing open gastrectomy.
Acta Pharmacologica Sinica ( IF 6.9 ) Pub Date : 2018-10-16 , DOI: 10.1038/s41401-018-0179-3 Joo-Hyun Lee 1 , Yeong-Jin Choo 2 , Yong-Hun Lee 3 , Jin-Ho Rhim 4 , Soo-Han Lee 5 , Byung-Moon Choi 3 , Sung-Tae Oh 6 , Kyu-Taek Choi 3 , Gyu-Jeong Noh 3, 7
Acta Pharmacologica Sinica ( IF 6.9 ) Pub Date : 2018-10-16 , DOI: 10.1038/s41401-018-0179-3 Joo-Hyun Lee 1 , Yeong-Jin Choo 2 , Yong-Hun Lee 3 , Jin-Ho Rhim 4 , Soo-Han Lee 5 , Byung-Moon Choi 3 , Sung-Tae Oh 6 , Kyu-Taek Choi 3 , Gyu-Jeong Noh 3, 7
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In order to maintain stable blood pressure and heart rate during surgery, anesthesiologists need to administer the appropriate amount of fluid with appropriate fluid type to the patient, then quantifying how fluid is distributed and eliminated from the body is useful for establishing a fluid administration strategy. In this study we characterized the volume kinetics of Ringer's lactate solution in patients undergoing open gastrectomy. When propofol and remifentanil reached a pseudosteady state at the target concentration and blood pressure was stabilized following surgical stimulation, enrolled patients were administered 1000 mL of Ringer's lactate solution for 20 min, followed by continuous infusion at a rate of 6 mL/kg/h until the time of the last blood collection for volume kinetic analysis. Arterial blood samples were collected to measure the hemoglobin concentration at different time points. The change in hemoglobin-derived plasma dilution induced by the administration of Ringer's lactate solution was evaluated by nonlinear mixed effects modeling. Three hundred and twenty-three plasma dilution data points from 27 patients were used to determine the pharmacokinetic characteristics of Ringer's lactate solution. A two-volume model best described the pharmacokinetics of Ringer's lactate solution. The mean arterial pressure (MAP) and body weight (WT) were significant covariates for the elimination clearance (kr) and central volume of distribution at baseline (Vc0), respectively. The parameter estimates were as follows: kr (mL/min) = 124 + (MAP/70)14.2, Vc0 (mL) = 0.95 + 3440 × (WT/63), Vt0 (mL) = 2730, and kt (mL/min) = 181. A higher MAP was associated with a greater elimination clearance and, consequently, less water accumulation in the interstitium. As body weight increases, volume expansion in the blood vessels increases.
中文翻译：
在接受开放胃切除术的患者中，乳酸林格氏溶液的基于群体的体积动力学。
为了在手术过程中保持稳定的血压和心率，麻醉师需要给患者注射适量的液体和适当的液体类型，然后量化液体在体内的分布和排出方式，有助于制定液体管理策略。在这项研究中，我们表征了接受开放胃切除术的患者中林格氏乳酸盐溶液的体积动力学。当丙泊酚和瑞芬太尼在目标浓度下达到假稳态且手术刺激后血压稳定时，入组患者给予 1000 mL 乳酸林格液 20 分钟，然后以 6 mL/kg/h 的速度持续输注，直至最后一次采血进行体积动力学分析的时间。收集动脉血样以测量不同时间点的血红蛋白浓度。通过非线性混合效应模型评估由给予乳酸林格氏溶液引起的血红蛋白衍生的血浆稀释度的变化。来自 27 名患者的 323 个血浆稀释数据点用于确定林格氏乳酸盐溶液的药代动力学特征。两体积模型最好地描述了林格氏乳酸盐溶液的药代动力学。平均动脉压 (MAP) 和体重 (WT) 分别是清除清除率 (kr) 和基线中心分布容积 (Vc0) 的显着协变量。参数估计如下：kr (mL/min) = 124 + (MAP/70)14.2, Vc0 (mL) = 0.95 + 3440 × (WT/63), Vt0 (mL) = 2730, and kt (mL/分钟）= 181。较高的 MAP 与较大的清除清除率相关，因此，间质中的水分积累较少。随着体重的增加，血管中的体积膨胀增加。
更新日期：2019-01-26
中文翻译：
在接受开放胃切除术的患者中，乳酸林格氏溶液的基于群体的体积动力学。
为了在手术过程中保持稳定的血压和心率，麻醉师需要给患者注射适量的液体和适当的液体类型，然后量化液体在体内的分布和排出方式，有助于制定液体管理策略。在这项研究中，我们表征了接受开放胃切除术的患者中林格氏乳酸盐溶液的体积动力学。当丙泊酚和瑞芬太尼在目标浓度下达到假稳态且手术刺激后血压稳定时，入组患者给予 1000 mL 乳酸林格液 20 分钟，然后以 6 mL/kg/h 的速度持续输注，直至最后一次采血进行体积动力学分析的时间。收集动脉血样以测量不同时间点的血红蛋白浓度。通过非线性混合效应模型评估由给予乳酸林格氏溶液引起的血红蛋白衍生的血浆稀释度的变化。来自 27 名患者的 323 个血浆稀释数据点用于确定林格氏乳酸盐溶液的药代动力学特征。两体积模型最好地描述了林格氏乳酸盐溶液的药代动力学。平均动脉压 (MAP) 和体重 (WT) 分别是清除清除率 (kr) 和基线中心分布容积 (Vc0) 的显着协变量。参数估计如下：kr (mL/min) = 124 + (MAP/70)14.2, Vc0 (mL) = 0.95 + 3440 × (WT/63), Vt0 (mL) = 2730, and kt (mL/分钟）= 181。较高的 MAP 与较大的清除清除率相关，因此，间质中的水分积累较少。随着体重的增加，血管中的体积膨胀增加。
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