【摘要】 背景 肥胖患者麻醉药药代与药效动力学较体重正常人群个体差异更大，其心输出量与身体肌肉、脂肪等组织构成比的变化影响众多麻醉药物分布、消除规律，按总体重给药易致药物过量，按理想体重给药则可能剂量不足。目的 本文阐述常用静脉麻醉药在肥胖患者中的药代与药效动力学特性，有助于此类患者合理用药，减少并发症。内容 综述肥胖患者常用静脉麻醉药按总体重、理想体重、体表面积和瘦体重用药研究现状。趋势 为避免肥胖患者肌松药术后残余作用所致并发症，非去极化肌松药按理想体重给药较合适，而大多数静脉麻醉药（包括阿片类药物）则适于按瘦体重给药。
Background Obese patients have greater differences than the normal weight ones in the anesthetic pharmacokinetics and pharmacodynamics, Changes in cardiac output and alterations in body composition affect the distribution of numerous anaesthetic drugs. As drug administration based on total body weight can result in over-dose.Inversely,administration of drugs based on ideal body weight can result in a subtherapeutic dose.Objective This review will focus on the pharmacokinetics and pharmacodynamics properties of intravenous anesthetic in obese patientsto help them rational application and reduce complications.Content Discussing dosing scalars including total body weight,ideal body weight, body surface area and lean body weight as well as its recent advances in clinical application of intravenous anaesthetics in the obese.Trend With the exception of the non-depolarizing neuromuscular blocking agents which IBW might be appropriate to avoid postoperative residual curarization,Lean body weight is the most appropriate dosing scalar for the majority of anaesthetic agents including opioids and anaesthetic-induction agents.
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