顺式阿曲库铵和罗库溴铵在老年患者中的药效学比较

Pharmacodynamics of cisatracurium and rocuronium in elderly patients

目的:观察单次静脉注射不同剂量的顺式阿曲库铵在老年患者中的药效学变化,并与壮年患者和罗库溴铵比较,为顺式阿曲库铵在老年患者麻醉中的应用提供参考。方法:择期全麻乳腺手术患者100例,根据年龄分为老年组(Ⅰ组)和壮年组(Ⅱ组),每组再分成4个亚组:罗库溴铵组(Ⅰ1,Ⅱ1)、顺式阿曲库铵2×ED95组(Ⅰ2,Ⅱ2),3×ED95组(Ⅰ3,Ⅱ3)和4×ED95(Ⅰ4,Ⅱ4),共8组。肌肉松弛监测采用4个成串刺激(train-of-four,TOF)。肌肉松弛效应观察指标包括:起效时间、TOF无反应期、T1恢复到25%,50%和75%的时间以及恢复指数。结果:老年组顺式阿曲库铵的起效时间稍长于壮年组,但差异无统计学意义;老年组顺式阿曲库铵的TOF无反应期、T1恢复到25%,50%和75%的时间及恢复指数均稍长于壮年组,但差异无显著性。老年组罗库溴铵起效时间明显长于其壮年组(P<0.05),且老年组肌肉松弛效应恢复的各项参数也均明显长于壮年组(P<0.05)。顺式阿曲库铵的肌松恢复指数在各组之间的差异无统计学意义。结论:对于女性而言,增龄对单次静脉注射顺式阿曲库铵的药效学无明显影响,对单次静脉注射罗库溴铵的药效学有显著影响。

Objective： To compare the pharmacodynamic profiles of different doses of cisatracurium and rocuronium in elderly and young patients.Methods： One hundred patients undergoing elective surgery were randomly divided into two groups according to age difference： elderly（I） and young（II） groups.The two groups were then divided into four subgroups： rocuronium（I1,II1）,cisatracurium 2×ED95 group（I2,II2）,cisatracurium 3×ED95 group（I3,II3）,cisatracurium 4×ED95 group（I4,II4）.Neuromuscular blocking effects were monitored using Biometer accelograph.Train-of-four（TOF,with 0.2ms square wave at frequency of 2Hz,every 12s） stimulation was applied.The onset time,duration of TOF＇s unavailability,times of T1 recovered to 25%,50%,75% and recovery index were observed.Results： The action onset and duration after cisatracurium injection were little but not significantly longer in elderly patients than those in young patients.The action onset and pharmacodynamic recovery parameters after rocuronium injection in elderly patients were significantly longer than those in young patients（P〈0.05）.The recovery index of cisatracurium in each group was not different.Conclusion： For women,aging has no influence on the pharmacodynamics of single injection of cisatracurium,while it influences that of single injection of rocuronium.