七氟烷对糖尿病和非糖尿病患者罗库溴铵肌松效应影响的比较

Comparison of effects of sevoflurane on neuromuscular blockade induced by rocuronium in patients with and without diabetes mellitus

目的比较七氟烷对糖尿病和非糖尿病患者罗库溴铵肌松效应的影响。方法择期腹部手术患者60例，年龄45～64岁，ASAⅡ级，其中Ⅱ型糖尿病患者30例，随机分为2组（n=15）：异丙酚组（PD组）和七氟烷组（SD组）；非糖尿病患者30例，随机分为2组（n=15）：异丙酚组（PN组）和七氟烷组（SN组）。静脉注射咪达唑仑、异丙酚和芬太尼行麻醉诱导后启动肌松监测，PD组和PN组静脉注射罗库溴铵0．6mg／kg后气管插管，静脉输注异丙酚维持麻醉；SD组和SN组1％地卡因充分表面麻醉后气管插管，吸入七氟烷（呼气末浓度1．71％）10min后静脉注射罗库溴铵0．6mg／kg，吸入七氟烷（呼气末浓度1．71％）维持麻醉。记录肌松起效时间、维持时间和恢复指数。于静脉注射罗库溴铵后10、20、30、40、50、60、70、80、90、100、110、120min时记录T1／T0比值及TOF比值（T4／T1比值）。结果PN组与PD组、SN组与SD组、PD组与SD组间罗库溴铵起效时间、维持时间比较差异无统计学意义（P〉0．05）。与SN组和PD组比较，SD组恢复指数延长（P〈0．05）。静脉注射罗库溴铵后60～120min，SD组T1／T0比值和TOF比值较PD组降低（P〈0．05）；静脉注射罗库溴铵后80—120min，SD组TOF比值较SN组降低（P〈0．05）。结论与非糖尿病患者相比，七氟烷对糖尿病患者罗库溴铵肌松效应的强化作用进一步增强。

Objective To compare the effects of sevoflurane on neuromuscular block induced by rocuronium in the patients with or without diabetes metlitus. Methods Thirty diabetic and 30 non-diabetic ASA Ⅱ patients aged 45-64 yr scheduled for elective middle or lower abdominal surgery were studied. Both diabetic and non-diabetic patients were randomly assigned to one of 2 groups （n = 15 each）： propofol group （group P） and sevoflurane group （group S）. All patients were anesthetized with midazolam, propofol and fentanyl. After loss of consciousness tracheal intubation was performed after rocuronium 0.6 mg/kg and anesthesia was maintained with iv propofol infusion in group P. In group S tracheal intubation was performed under topical anesthesia with 1% amethacaine injected through cricothyroid membrane. Anesthesia was maintained with sevoflurane inhalation （endtidal concentration 1.71 % ）. Rocuronium 0.6 mg/kg was given iv at 10 min after inhalation of sevoflurane was started. Neuromuscular function was assessed by accelerography （TOF-Watch SX, Organon, Holland）. TOF stimulation of ulnar nerve was used. The onset time, duration of action and recovery index （for T1 to return from 25% to 75% of the control twitch） were recorded. The T1/T0 and TOF （T4/T1） ratios were recorded at 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 110 and 120 min after a single bolus of rocuronium. Results There was no significant difference in onset time and duration of action between diabetic and non-diabetic patients in beth propofol and sevoflurane groups. The recovery index was significantly higher in diabetic patients than in non-diabetic patients in group S. The recovery index was significantly higher in group S than in group P in diabetic patients. The ratios of T1/T0 and TOF were significantly lower in group S than in group P in diabetic patients during 60-120 rain after a single bolus of rocuronium. The TOF ratio was significantly lower in diabetic patients than in non-diabetic patients in group S during 80-120 min after a single bolus of rocuronium. Conclusion The effect of sevoflurane on roeuronium-induced neuromuscular block is enhanced in diabetic patients compared with non- diabetic patients.