终末期肝病患者罗库溴铵的代谢途径

Metabolic pathway of r ocuronium in patients with end-stage liver disease

目的探讨终末期肝病患者罗库溴铵的代谢途径。方法拟行肝移植术的终末期肝病患者20例，年龄21-64岁，体重54～80kg，ASAⅡ级或Ⅲ级。静脉注射异丙酚、芬太尼和罗库溴铵麻醉诱导，气管插管后机械通气。采用四个成串刺激监测肌松程度。麻醉维持：静脉输注异丙酚，吸人N2O，间断静脉注射芬太尼；待L恢复到5％时，颈内静脉输注罗库溴铵，初始输注速率为3μg·kg^-1·min^-1，调节输注速率维持T15％～15％。记录无肝前期、无肝期及新肝期罗库溴铵用量，无肝期与无肝前期罗库溴铵用量的比值与术前Child-Pugh评分进行直线相关分析。结果无肝前期、无肝期、新肝期罗库溴铵用量分别为3．2±1．2、1．7±0．6、（2．1±0．7）μg·kg^-1·min^-1，无肝期和新肝期罗库溴铵用量较无肝前期下降（P〈0．01），新肝期较无肝期罗库溴铵用量增加（P〈0．01）。无肝期罗库溴铵用量为无肝前期的（54±16）％，无肝期与无肝前期罗库溴铵用量的比值与术前Child—Pugh评分成正相关（r=0．54，P〈0．05）。结论终末期肝病患者罗库溴铵更多地依赖肝外代谢。

Objective To investigate the metabolic pathway of rocuronium in patients with end2stage liver disease. Methods Twenty ASA Ⅱ or Ⅲ patients aged 21-64 yr weighing 54-80 kg with end-stage liver disease undergoing OLT were enrolled in this study. Anesthesia was induced with propofol, fentanyl and rocuronium. The patients were mechanically ventilated after tracheal intubation. Changes in adductor pollicis muscle were monitored by the train of four （TOF） stimulation. Anesthesia was maintained with iv propofol infusion, N20 inhalation, intermittent iv fentanyl. When TI was returned to 5%, rocuronium was infused iv with the initial rate at 3 μg·kg^-1 ·min^-1 and then adjusted to maintain T1 of the twitch height at 5%-15%. The amount of rocumnium administered during pre-anhepatic, anhepatic and neohepatic phase was recorded. Correlation between the ratio of the amount of rocuronium administered during anhepatic phase to the amount administered during pre-anhepatic phase and the Child-Pugh score was analyzed. Results The amount of rocuronium administered during preanhepatic, anhepatic and neohepatic phase was 3.2 ± 1.2, 1.7 ± 0.6 and （2.1 ± 0.7） μg · kg^-1 · min^-1 respectively. The amount of rocuronium administered during anhepatic and neohepatic phase was lower than that during pre-anhepatic phase （P 〈 0.01）. The amount of rocuronium administered during neohepatic phase was higher than that during anhepatic phase （P 〈 0.01）. The amount of rocuronium administered during anhepatic phase was （54 ± 16） % of that during pre-anhepatic phase. The ratio of the amount of rocuronium administered during anhepatic phase to the amount administered during pre-anhepatic phase was positively correlated with the Child-Pugh score （ r = 0.54, P 〈 0.05 ）. Conclusion The metabolism of rocuronium may depend more on the extrahepatic organs in patients with end-stage liver desease.