性别因素对七氟醚增强顺阿曲库铵或罗库溴铵肌松效应的影响

Influence of gender on enhancement of neuromuscular blocking effects of cisatracurium or rocuronium by sevoflurane

目的 探讨性别因素对七氟醚增强顺阿曲库铵或罗库溴铵肌松效应的影响.方法 择期全麻手术患者240例,年龄20～60岁,ASA分级Ⅰ或Ⅱ级,BMI 20～30 kg/m2,随机分为2组（n=120）：顺阿曲库铵组和罗库溴铵组,各组按性别和麻醉药再分4个亚组（n=30）：女性异丙酚组、男性异丙酚组、女性七氟醚组和男性七氟醚组.各异丙酚组靶控输注异丙酚,血浆靶浓度2～6 μg/ml,各七氟醚组吸入七氟醚,于靶控输注或待呼气末七氟醚浓度稳定于1.71%5 min后,静脉注射顺阿曲库铵0.15 mg/kg或罗库溴铵0.6 mg/kg.记录肌松起效时间、肌松作用峰值时间、T1 25%恢复时间和TOFR25%恢复时间.结果 与异丙酚麻醉比较,女性患者七氟醚麻醉时,罗库溴铵TOFR 25%恢复时间延长,顺阿曲库铵肌松作用峰值时间、T1 25%恢复时间和TOFR 25%恢复时间延长,男性患者七氟醚麻醉时,罗库溴铵起效时间缩短,肌松作用峰值时间、T1 25%恢复时间和TOFR 25%恢复时间延长,顺阿曲库铵肌松作用峰值时间、T1 25%恢复时间和TOFR 25%恢复时间延长（P＜0.05或0.01）;七氟醚麻醉时与男性患者比较,女性患者罗库溴铵T1 25%恢复时间和TOFR 25%恢复时间缩短,顺阿曲库铵起效时间缩短（P＜0.05或0.01）.结论 七氟醚对罗库溴铵肌松的增强作用存在性别差异,男性强于女性;对顺阿曲库铵肌松的增强作用无明显性别差异.

Objective To investigate the influence of gender on the enmcement of neuromuscular blocking effects of cisatracurium or rocuronium by sevoflurane. Methods Two hundred and forty ASA Ⅰ or Ⅱ patients, aged 20-60 yr, weighing 45-85 kg, scheduled for elective surgery under general anesthesia were assigned into 2 groups （ n = 120 each）： cisatracurium group and rocuronium group. Each group were divided into 4 subgroups according to gender and anesthetics （ n = 30 each）： female propofol group, male propofol group, female sevoflurane group and male sevoflurane group. Anesthesia was induced with midazolam, propofol and fentanyl. After loss of consciousness, the laryngeal mask was inserted and the patients were mechanically ventilated. Propofol groups received target-controlled infusion （TCI） of propofol （target plasma concentration 2-6 μg/ml）, and sevoflurane groups inhalation of sevoflurane. Cisatracurium 0.15 mg/kg or rocuronium 0.6 mg/kg was injected intravenously 5 min after propofol infusion or after the end-tidal concentrion of sevoflurane was maintained at 1.71% （1 MAC） for 5 min. Neuromuscular block was assessed with accelerograph F （TOF-watch SX）. Train-of-four （TOF） stimulation of ulnar nerve was used. The onset time, duration of peak effect and times for recovery of T1 to 25% and TOF ratio （TOFR） to 25% were recorded.Results Compared with propofol groups, the time for recovery of TOFR to 25 % for rocuronium, and the duration of peak effect and times for recovery of T1 to 25 % and TOFR to 25% for cisatracurium were significantly prolonged in female sevoflurane group, the onset time of rocuronium was significantly shortened, while the duration of peak effect and times for recovery of T1 to 25% and TOFR to 25% for rocuronium and cisatracurium were significantly prolonged in male sevoflurane group （ P ＜ 0.05 or 0.01 ）. The times for recovery of T1 to 25% and TOFR to 25% for rocuronium and onset time of cisatracurium were significantly shorter in female than in male during sevoflurane anesthesia （P ＜ 0. 05 or 0.01 ）. Conclusion The enhancement of rocuronium-induced neuromuscular block by sevoflurane is stronger in male than in female,but there is no gender variation in the enhancement of cisatracurium-induced neuromuscular block by sevoflurane.