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活体肝移植术供体右半肝切除后罗库溴铵用量的变化 被引量:1

Changes in dose requirements of rocuronium after right hemihepatectomy in donor for living donor fiver transplantation
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摘要 目的探讨活体肝移植术供体右半肝切除术后罗库溴铵用量的变化。方法.择期拟行右半肝切除术的肝移植术供体病人16例,年龄2149岁,体重51~86kg,ASA工级。麻醉诱导:静脉注射眯达唑仑和芬太尼,靶控输注异丙酚和罗库溴铵(血浆靶浓度3μg/ml),采用肌松监测,待T1/Tc=0时进行气管插管,机械通气。气管插管后罗库溴铵血浆靶浓度降至1.0μg/ml,调整罗库溴铵浓度,维持0〈T1≤10%。麻醉维持:吸人七氟烷,靶控输注异丙酚,间断静脉注射芬太尼。于第2次胆道造影前停用罗库溴铵和七氟烷,记录此时(切肝前)罗库溴铵输注时间、用药量及停药后肌松恢复情况。待右半肝切除后继续给予罗库溴铵和七氟烷。缝合腹膜后,再次停用罗库溴铵和七氟烷,记录此时(切肝后)罗库溴铵输注时间、用药量及停药后肌松恢复情况。结果与切肝前相比,切肝后罗库溴铵单位时间用量减少(P〈0.05),切肝后罗库溴铵单位时间用量为切肝前的(67±13)%。结论肝移植术供体病人右半肝切除可影响罗库溴铵的代谢。 Objective To investigate the changes in the dose requirements of rocuronium after right hemihepatectomy in donor of living donor liver transplantation. Methods Sixteen ASA I patients of living donor liver transplantation, aged 21-49 yr, weighing 51-86 kg, scheduled for right hemihepatectomy, were enrolled in this study. Anesthesia was induced with iv midazolam and fentanyl, and TCI of propofol and rocuronium. Changes in adductor pollicis muscle were monitored by the train of four (TOF) stimulation. The patients were mechaincally ventilated after tracheal intubation when T1/Tc = 0. The target plasma concentration of rocuronium was reduced to 1.0 μg/ml after tracheal intubation and the concentration was regulated to maintain 0 〈 T1≤ 10%. Anesthesia was maintained with sevoflurane inhalation, TCI of propofol, intermittent iv injection of fentanyl. The infusion of rocuronium and inhalation of sevoflurane were stopped before the second time of cholangiography, the total time and amount of rocnronimn administered and the recovery of muscle relaxation were recorded at this time (before hemihepatectomy). The infusion of rocuronium and inhalation of sevoflurane were restarted after right hemibepatectomy. After the peritoneum was closed, the infusion of rocuronium and inhalation of sevoflurane were Stopped again, the total time and amount of rocuronium administered and the recovery of muscle relaxation were also recorded at this time (after hemihepatectomy ). Results The amount of rocuronium administered was significantly reduced after hemihepatectomy compared with that before hemihepatectomy ( P 〈 0.05). The amount of rocuronium administered after hemihepatectomy was (67± 13) % of that before hemihepatectomy. Conclusion Right hemihepatectomy can affect the metabolism of rocuronium in the donor of living donor liver transplantation.
出处 《中华麻醉学杂志》 CAS CSCD 北大核心 2009年第7期585-587,共3页 Chinese Journal of Anesthesiology
关键词 雄甾烷醇类 肝移植 药代动力学 Androstanols Liver transplatation Pharmacokinetics
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  • 1Korinek JD, Thomas RM, Goddard LA, et al. Comparison of ro- curonium and succinylcholine on postintubation sedative and anal- gesic dosing in the emergency department [J]. Eur J Emerg Med, 2014, 21(3): 206-211.
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  • 3Hudson ME, Rietbergen H, Chelly JE. Sugammadex is effective in reversing rocuroninm in the presence of antibiotics [J]. BMC Anes- thesiol, 2014, 14: 69.
  • 4Gyermek L, Lee C, Nguyen N. Pharmacology of G-1-64, a new nondepolarizing neuromuscular blocking agent with rapid onset and short duration of action [J]. Acta Anaesthesiol Scand, 1999, 43(6): 651-657.
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