肝移植术患者术前肝功能对罗库溴铵药效学的影响

Effects of preoperative liver function on phamarcodymics of rocuronium in patients orthotopic liver transplantation

目的探讨肝移植术患者术前肝功能对罗库溴铵药效学的影响。方法按CTP肝脏功能分级将21例患者分为A组(CTP A级)、B组(CTP B级)和C组(CTP C级),每组7例。麻醉诱导后待T1恢复至75%时,泵入罗库溴铵,维持T1于25%。再次静推罗库溴铵0.6 mg/kg,进行相同观察,并持续泵注罗库溴铵维持T1于25%水平。无肝期即刻停止泵入罗库溴铵,当再次肌松恢复至T1 75%时,泵入罗库溴铵使其维持T1于25%水平。新肝期开始待T1于25%水平稳定后,第3次静推罗库溴铵0.6 mg/kg。监测3次静脉注射罗库溴铵后的起效时间、最大阻滞程度、无反应时间、临床时效、T1 25%～50%时间和恢复指数。结果首剂量罗库溴铵0.6 mg/kg,B、C组的起效时间明显长于A组(P<0.05);C组的临床时效、T1 25%～50%恢复时间和恢复指数比A、B组显著延长(P<0.05)。无肝前期第2次罗库溴铵,B、C组的临床时效比A组显著延长(P<0.05)。无肝期罗库溴铵的T1 25%～50%恢复时间在各组间差异无统计学意义。新肝期C组的T1 25%～50%恢复时间和恢复指数比A、B组显著延长(P<0.05)。结论肝功能CTP C级患者行肝移植术中,使用罗库溴铵麻醉诱导时应延长插管时间,在无肝前期及新肝期减少追加药量,并延长追加用药的时间。

Objective To investigate the effects of preoperative liver function on phamarcodymics of rocuronium in patients orthotopic liver transplantation （OLT）. Methods Twentyone adult patients with end-stage liver disease were divided into three groups of Child-Turcotte-Pugh class A （CTP class A）,B （CTP class B） and C （CTP class C） with 7 cases each. The response of adductor pollicis to single twitch was monitored. The infusion rates of rocuronium were adjusted to maintain T1 of 25% after T1 was recovered to 75% and then second bolus of rocuronium 0.6 mg/kg was given during the paleohepatie phase（PP）. Stopping infusion of rocuronium at the beginning of anhepatic phase（AP）, and starting infusion of rocuronium to maintain T1 of 25% after T1 was recovered to 75%. Then a third bolus dose of rocuronium 0.6mg/kg was given during the neohepatic phase（NP）. Results Onset of the initial dose of rocuronium in group B [（232.9±97.6） s] and C [（253.6±82.5） s] was longer than that in group A [（155.3±20. 3） s] （P〈0. 05）. Furthermore, duration of action[（56.00 ± 20. 16） min, T1 25%-50% recovery time[（22.71 ± 8. 44） min and recovery index[（44.50± 21.56） mini of the initial dose of rocuronium was significantly prolonged during paleohepatic period in group C （P〈0.05）. There were no differences in T1 25%-50% recovery time among three groups. The T1 25%-50% recovery time and recovery index were longer in group C than those in groups of A and B during the neohepatic phase （P〈0.05）. Conclusion In the patients with CTP class C of preoperative liver function, it is reasenable to prolong the introduction time and decrease the incremental dosage of rocuronium during the paleohepatic phase and neohepatic phase during OLT.