癫痫患者顺式阿曲库铵的剂量反应曲线测定

The measurement of dose-response curve of cisatracurium in epilepsy patients

目的 采用单次剂量注射法建立癫痫患者顺式阿曲库铵的剂量反应曲线,确定其量效关系及ED95,为癫痫患者合理应用顺式阿曲库铵提供依据.方法 选取择期癫痫手术患者40例,ASA Ⅰ～Ⅱ级,年龄16岁～42岁,病史3年～26年,均具有服用抗癫痫药物史,术前无酸碱平衡及水电解质紊乱,心肺、肝肾功能正常.患者按随机数字法分为20μg/kg组、30μg/kg组、40 μg/kg组、50μg/kg组共4个剂量组,每组10例.记录拇内收肌四个成串刺激反应中第1次反应最大抑制的百分率,并进行概率单位转换,将顺式阿曲库铵的首次剂量进行对数转换,用直线回归方法建立顺式阿曲库铵的剂量-反应曲线,并记录起效时间.结果 癫痫患者顺式阿曲库铵ED50、ED75、ED90、ED95值分别为36.3、46.1、57.4、65.4μg/kg,起效时间在4个剂量组之间差异无统计学意义（P＞0.05）.结论 本研究测得癫痫患者顺式阿曲库铵ED95值为65.4 μg/kg,比目前临床采用的正常人ED9550μg/kg增加30.8%.

Objective To determine the dose-response curve and the ED95 of cisatracurium in epilepsy patients. Methods Forty ASA grade Ⅰ or Ⅱ epilepsy patients were randomly divided into four groups. The dose-response curve was determined by single bolus injection of cisatracurium under midazolam-fentanyl intravenous anesthesia. For each group, the dose of cisatracurium were 20,30, 40 and 50 μg/kg respectively. The neuromuscular block was measured by Neuromuscular Transmission Monitor, and the responses were defined in terms of the percentages of maximum suppression in T1 of TOF of the adductor pollicis muscle. After logprobit transformation of the data of dose and response, the dose-response curve of cisatracurium was then established by linear regression. The onset time of cisatracurium was also recorded. Results The ED50, ED75, ED90 and ED95 of cisatracurium in epilepsy patients were 36.3, 46.1, 57.4 and 65.4 μg/kg. There was no significant change in onset time among 4 groups. Conclusion The ED95 of cisatracurium in epilepsy patients is 65.4 μg/kg, which is about 30.8% higher than that in normal human.