NSIADs与麻醉药的相互作用中国医科大学附属第一医院麻醉科吕黄伟与阿片类药物-----临床效应静脉麻醉药吸入麻醉药苯二氮卓类药物NSIADs与阿片类药物NSIADs阿片类药物的用量吗啡的副作用（恶心、呕吐）其他促进肠蠕动PCA吗啡用量减少25%Anesthesiology,1994,80(6):336-342.前列腺切除术硬膜外芬太尼用量减少40%Anesthesiology,1993,78(4):642-648.Ketorolac30mgim减少PCA芬太尼用量约21%帕瑞昔布钠40mg/12hrivTHANKYOUFlurbiprofenAxetilCanDecreaseCp50incisionofFentanylunderPropofolAnesthesiaAnesthesiology2007;107:A1654(ASAI-II,ages20–55)gynecologiclaparoscopy•Controlgroup:n=27•Flurbiprofenaxetil:n=27,1mg/kgivPropofolCE:5µg/ml.succinylcholine1mg/kg.HPLC:fentanyl方法THANKYOUAnesthesiology2007;107:A16Cgroup:1.51±0.97ng/mlFgroup:0.51±0.34ng/ml(P=0.038)FlurbiprofenAxetilCanDecreaseCp50incisionofFentanylunderPropofolAnesthesia与阿片类药物NSIADs阿片类药物的用量吗啡的副作用（恶心、呕吐）其他促进肠蠕动THANKYOUTHANKYOUTHANKYOU对皮肤瘙痒、尿潴留和呼吸抑制没有影响与阿片类药物NSIADs减少吗啡的用量减少吗啡的副作用（恶心、呕吐）其他促进肠蠕动THANKYOUTHANKYOU小结减少术后镇痛（静脉或硬膜外）的阿片类用量减少阿片类副作用（恶心、呕吐）促进肠道蠕动与阿片类药物静脉麻醉药----药代动力学水平吸入麻醉药苯二氮卓类药物NSIADsTHANKYOU40mgparecoxibTHANKYOU40mgparecoxibTHANKYOU40mgparecoxibTHANKYOU40mgparecoxibTHANKYOU40mgparecoxibTHANKYOUTHANKYOUFlurbiprofenAxetilForPreventionOfPropofolInjectionPainInAdult---ASystematicReview.TheInternetJournalofAnesthesiology.201128（1）67%24%60%13%小结对丙泊酚的药代动力学和药效动力学没有影响减少注射痛与阿片类药物静脉麻醉药吸入麻醉药----MAC苯二氮卓类药物NSIADsEffectsofbutorphanolandcarprofenontheminimalalveolarconcentrationofisofluraneindogs.JAmVetMedAssoc,2000,217(7):1025-1028.Control:carprofen:2.2mg/kgbutorphanol:0.4mg/kgcontrol:1.28±0.14%carprofen:1.20±0.13%butorphanol:1.03±0.22%Carprofen+butorphanol:0.90±0.21%Control:1.24%±0.15%Carprofen:1.13%±0.13%Morphine:0.81%±0.18%Carprofen+morphine:0.68%±0.31%EffectsofCarprofenandMorphineontheMinimumAlveolarConcentrationofIsofluraneinDogsJournaloftheAmericanAnimalHospitalAssociation2009,45:19-23.Carprofen:2.2mg/kgperosMorphine:1mg/kgIVCarprofen+morphine.方法Paracetamol,醋氨酚：300mgkg,Metamizole,(Dipyrone),安替比林：15mg/kg,Ketoprofen,酮洛芬：2mg/kg,Parecoxib,帕瑞昔布：30mg/kg.Remifentanil，120μg/kg/h方法方法THANKYOUTHANKYOUTHANKYOU结论NSIADs可加强阿片类药物降低吸入麻醉药的MAC。各种NSIADs差别较大，醋氨酚最明显。所有NSIADs可预防阿片类药物的耐受。THANKYOU小结NSIADs和阿片类复合应用降低吸入麻醉药的MAC。NSIADs单独应用对MAC的影响不定。与各种NSIADs有关。与阿片类药物静脉麻醉药吸入麻醉药苯二氮卓类药物---药效学NSIADsTHANKYOUMidazolamand1-hydroxymidazolamplasmaconcentration0.07mg/kgMidazolamParecoxib40mgIVTHANKYOUTHANKYOUTHANKYOU小结NSIADs对苯二氮卓类药物药代动力学没有影响。可能影响药效动力学。肝脏代谢---P450参与NSAIDs氧化代谢的细胞色素P450酶系,主要有：CYP2C9（氟比洛芬酯、伐地昔布）CYP1A2CYP2E1CYP3A4（伐地昔布）细胞色素P450同工酶-CYPNSAIDsPropofolSevofluraneMmidazolamFentanylRopicaaineCYP2C92C91A2，3A41A2,3A42A6,3A(肾)3A4.23A41A2和3A42E12C8,2C19,2C182E12B6,2B13M.16总结与阿片类药物静脉麻醉药吸入麻醉药苯二氮卓类药物减少吗啡的用量药代和药效学没有影响与阿片类合用降低吸入麻醉药的MAC不影响药代动力学没有影响。减少吗啡的副作用减少注射痛可影响影响药效动力学。THANKYOU
