年龄对罗库溴铵靶控输注时效的影响

Effect of age on pharmacodynamics of rocuronium TCI

目的探讨靶控输注(TCI)罗库溴铵时年龄对其药效学的影响。方法选择ASAⅠ或Ⅱ级、无神经肌肉疾患、接受丙泊酚-N2O/O2-芬太尼复合麻醉的患者30例,根据年龄分为老年组和青壮年组,每组15例。在静脉注入罗库溴铵0.6 mg/kg后用加速度仪采用四个成串刺激(TOF)方式监测拇内收肌的收缩反应。待T1恢复至10%时开始TCI罗库溴铵,靶控血浆浓度为2μg/ml。记录神经肌肉阻滞的最大阻滞时间及起效时间、恢复时间,并记录罗库溴铵的用药量。结果老年组的平均输注速率为(7.6±0.9)μg.kg-1.min-1,青壮年组的平均输注速率为(8.2±0.8)μg.kg-1.min-1。单次注入罗库溴铵0.6 mg/kg后的起效时间,两组间差异无统计学意义。青壮年组的肌松恢复过程明显快于老年组,表现为单次注药后老年组的无反应期明显长于青壮年组(P<0.01);停止TCI后T1恢复到25%、50%和75%的时间及恢复指数,老年组都明显长于青壮年组(P<0.01)。但老年组罗库溴铵的平均用药量明显少于青壮年组(P<0.01)。两组术中肌松均维持平稳。结论罗库溴铵采用TCI在老年患者用药量虽然相应减少,但其恢复过程仍较青壮年组延长。

Objective To study the effect of age on the pharmacodynamics of rocuronium administered by target continuous infusion （TCI）. Methods Thirty ASA class Ⅰ or Ⅱ surgical patients under anesthesia with propofol-N2 O/O2-fentanyl were divided into elderly group in = 15, mean age（72.7 ±5.5）years old ]and younger group in= 15,mean age （45.0±9.3）years old]. After rocuronum 0, 6 mg/kg was given intravenously, the responses of adductor pollicis to train-of four （TOF） stimulation of the ulnar nerve were monitored. The infusion of rocuronium by TCI was started when T1 was at 10 %. The onset time, the time of maximal neuromuscular blockade, the spontaneous recovery from paralysis and the dose of rocuronium used were recorded. Results The two groups were comparable with regard to body weight, high, sex and duration of operation expect the age. In elderly group,the mean infusion rate was （7.6 ± 0.9）μg · kg^-1 · min^- 1 which was significantly different from （8.2±0.8）μg · kg^-1 · min^- 1 in younger group. The onset time of rocuronium in the elderly was similar to that in the younger [（87.0±16.2） vs （83.0±14.9） s]. The spontaneous recovery from neuromuscular block was significantly longer in elderly group than that in younger group. Conclusion The mean infusion rate of rocuronium TCI is significantly decreased,but the spontaneous recovery is longer in the elderly than that in the younger.