肝硬化患者血浆胆碱酯酶活性对麻醉剂米库氯铵代谢的影响

Effects of Plasma Cholinesterase Activity on the Metabolism of Mivacurium(Anesthetic) in Patients with Hepatocirrhosis

目的探讨肝硬化患者血浆胆碱酯酶(plasma cholinesterase,PchE)活性对麻醉剂米库氯铵代谢的影响,为临床麻醉提供指导。方法选取2016年10月~2018年10月接受全麻手术的患者70例,分为肝硬化组(n=35)和非肝硬化组(n=35),麻醉开始前采集静脉血检测PchE活性,使用同样的麻醉药物及麻醉方法,肌松监测采用四个成串刺激(train of four stimulation,TOF)。首次给予米库氯铵后记录作用时间(首剂作用时间),术中维持阶段采用持续泵注,手术结束前停止泵注的时间肝硬化组早于非肝硬化组10 min,然后分别记录四个成串刺激比值(train of four stimulation ratio,TOFr)恢复到25%,50%和75%的时间。术中记录的一般观察指标为手术时长、出血量和输液量。最后分析两组间PchE的活性和恢复时间之间的关系。结果肝硬化组的PchE活性(4 174±799U/L)明显低于非肝硬化组(6274±1151U/L),差异有统计学意义(t=8.865,P=0.000)。肝硬化组的首剂作用时间(20.3±3.7 min)长于非肝硬化组(16.3±3.3min),差异有统计学意义(t=4.767,P=0.000)。肝硬化组的TOFr恢复到25%,50%和75%的时间(26.2±8.0,31.8±8.3,33.8±10.6 min)明显长于非肝硬化组(16.0±4.0,20.4±3.9,24.1±4.6 min),差异均有统计学意义(t=6.683,P=0.000;t=7.355,P=0.000;t=4.960,P=0.000)。两组患者的手术时长、出血量、输液量比较,差异均无统计学意义(t=1.227,P=0.224;t=0.643,P=0.000;t=1.624,P=0.109)。结论肝硬化患者的PchE活性明显下降,对米库氯铵的代谢时间延长,掌握其代谢特点对临床麻醉有重要意义。

Objective To investigate the effects of PchE activity on the metabolism of mivacurium(Anesthetic)in patients with hepatocirrhosis,and provide a guidance for clinical anesthesia.Methods 70 patients who received operation were selected from October 2016 to October 2018.All patients were divided into ahepatocirrhosis group(n=35)and a non hepatocirrhosis group(n=35).To detect PchE activity by collecting venous blood before the start of anesthesia.Every patient was used the same anesthetics and anesthesia methods.Muscular relaxation monitor was applied with a train of four stimulation(TOF).To record the time of action after the first administration of mivacurium(first dose time).Continuou pumping was used during the maintenance phase of operation.The time of stopping pumping before the end of operation in hepatocirrhosis group was 10 minutes earlier than that in non hepatocirrhosis group,and record the times of TOFr(recovery to 25%,50%and 75%).The general observational indexes recorded during the operation were the length of operation,the amount of bleeding and the amount of infusion.Lastly,the relationship between PchE activity and recovery time between the two groups was analyzed.Results The PchE activity was less in the hepatocirrhosis group(4 174±799 U/L)compared with non hepatocirrhosis group(6 274±1 151 U/L)significantly(t=8.865,P=0.000).The duration of the first dose were 20.3±3.7 min,16.3±3.3 min respectively(t=4.767,P=0.000).The recovery time of TOFr(recovery to 25%,50%and 75%)were 26.2±8.0,31.8±8.3,33.8±10.6 min in hepatocirrhosis group,and 16.0±4.0,20.4±3.9,24.1±4.6 min in non hepatocirrhosis group.There were significant differences between the two groups(t=6.683,P=0.000;t=7.355,P=0.000;t=4.960,P=0.000).There were no significant differences in the length of operation,the amount of bleeding and the amount of infusion between the two groups(t=1.227,P=0.224;t=0.643,P=0.000;t=1.624,P=0.109).Conclusion The activity of PchE in patients with hepatocirrhosis was significantly decreased,and the metabolic time of mivacurium was prolonged.It is important for clinical anesthesia to master the metabolic characteristics of mivacurium.