胆汁淤积患者罗库溴胺药效学的变化

Pharmacodynamic changes of rocuronium in patients with cholestasis

目的:观察胆汁淤积伴或不伴肝细胞损伤患者罗库溴胺药效学的变化。方法:60例择期全身麻醉下行胆总管结石切除术、Roux-en-Y分流术或胃切除术患者,分成3组(n=20),Ⅰ组为伴有肝细胞损伤的胆汁淤积患者,Ⅱ组为不伴肝细胞损伤的胆汁淤积患者,Ⅲ组(对照组)为肝功能正常患者。全身麻醉诱导后,静注罗库溴胺0.6mg/kg,肌松后气管插管,间断追加罗库溴胺0.15mg/kg维持肌松。采用四个成串刺激监测肌松程度,记录罗库溴胺首剂的起效时间、首剂和重复追加剂量的维持时间及停药后的恢复指数。结果:3组间罗库溴胺首剂的起效时间和作用维持时间无明显差异。与第1次追加后作用维持时间相比,Ⅰ组第4、5次追加后作用维持时间分别从(22±4)min延长至(31±8)min、(38±11)min,Ⅱ组分别从(21±4)min延长至(28±5)min、(33±9)min(P<0.05),Ⅲ组则无明显变化。与Ⅲ组比较,Ⅰ、Ⅱ组第4、5次追加后作用维持时间与恢复指数明显延长(P<0.05)。结论:与肝功能正常患者比较,胆汁淤积患者使用罗库溴胺时,首剂的起效时间和维持时间无明显改变,多次重复用药维持时间则明显延长。胆汁淤积伴与不伴肝细胞损伤患者之间罗库溴胺药效学无明显差异。

Objective To observe the pharmacodynamic ebanges of rocurunium in eholestatic patients with or without hepatoeellular injury. Methods 60 patients nndergning choledocholitbotomy, Roux-cn-Y gastric bypass surgery, or gastrectomy were allocated into 3 groups （each n = 20） ： group Ⅰ, eholestatic patients with hepatocellular damage; group Ⅱ, cholestatic patients without hepatocellular damage; and group Ⅲ （control group）, patients with normal hepatic function. After anesthesia induction, 0.6 mg/kg roeurnnium was intravenously injected to facilitate endotracheal intubation, then 0.15 mg/kg rocuronium was intennittently repealed to maintain neuromuscular blocking. The level of neuromuscular blocking was monitored by train of 4 stimulation. The onset time of the initial dose, the duration time of the initial and the repeated doses, and the recovery index were recorded. Results The onset and the duration times of the initial dose were not significantly different among the three groups. After administration of the 4th and 5th repeated doses, the duration time prolonged from （22 ± 4） rain of the 1st repeated dose to （31 ± 8） rain and （38 ± 11） rain in group Ⅰ, and from （21 - 4） min to （28 ± 5） min and （33 ± 9） rain in group Ⅱ, respectively （P 〈 0.05）. The duration time and the recovery index of the 4th and 5th repeated doses were longer in groups Ⅰ and Ⅱthan those in group Ⅲ （P 〈 0.05）. Conclusions Cholestatic patients experience the normal onset and duration time of rocuronium of the initial dose, but the duration times after several repeated administration are significantly prolonged. There is no significant difference of pharmaeodynamics of roeuronium between cholestatic patients with or without hepatocellular damage.