急性中度等容性血液稀释对潘库溴铵量-效关系的影响

The dose-response relationship of pancuronium during acute moderate isovolemic hemodilution.

选择ＡＳＡＩ级行整形外科手术患者３０例随机分成两组：对照组（Ｃ）和血液稀释组（Ｈ）。在麻醉平稳后，手术开始前对Ｈ组患者行急性血液稀释达中度（血球压积平均２８．０４％）。试验中选用加速度仪的四个成串刺激（ＴＯＦ）形式监测神经肌肉功能，用小样本累积给药技术测定两组患者的潘库溴铵量-效关系的变化。结果表明：Ｃ组的潘库溴铵ＥＤ５０、ＥＤ９０、和ＥＤ９５、分别平均为２２．８５±６．９８、４５．２０±７．５１和４７．９９±７·６９μｇ／ｋｇ，Ｈ组的相应数值分别比Ｃ组增加了３２．４２％、２５．５５％和２５．１５％。急性中度等容性血液稀释使潘库溴争的量－效曲线有移，药效明显减弱。

The thirty patients ASA grade I undergoing plastic surgery were randomly divided into two groups: control (C)group and hemodilution (H)group. Following induction of anesthesia, the status of acute moderate isovolumic hemodllution (AMIH )was developed by the drawing-off of the venous blood and intravenous infusion of 6% dextron and lactate Ringer's solution,during which the levels of hemotocrit and hemoglobin dropped to 25~30% and 101. 1g. L-1 respectively,and the electrolytes and body temperature kept in normal range. The neuromuscular function was monitored by TOF stimulation mode of accelerometry with the Percentage deptesslon of T1 response serving as the parameter. The dose-response relations of pancuronium (Pan)in both groups were determined by the cumulative dose-response method. The results showed that the ED50,ED90 and ED95 of Pan in C group were 22. 8 6. 98,45. 22 7. 51 and 47. 99 7. 69g/kg respectively,and those in H group were 30. 26t 8. 15, 56. 75 10. 23 and 60. 06 10. 58 ig/kg separately,and there were signficant differences in them between both groups (P<0. 05 ). The dose--response curve in H grab parallelly shifted to the right as compared with one in C group. It's concluded that during AMIH the potency of Pan can reduce dramatically,which may be related to the decrease of its plasma concentration resulting from the increase of distribution volume and the relative reduction of the blood flow in skeleton muscles.