梗阻性黄疸患者应用顺式阿曲库铵的肌肉松弛时效观察

TIME -COURSE EFFECT OF CISATRACURIUM IN PATIENTS WITH OBSTRUCTIVE JAUNDICE

目的观察顺式阿曲库铵(cisatracurium)用于梗阻性黄疸患者的肌肉松弛时效以及术后肌肉松弛残留情况。方法择期全麻手术患者60例,美国麻醉医师协会分级Ⅰ～Ⅲ级,分为2组,观察组(Ⅰ组)30例,为梗阻性黄疸患者;对照组(Ⅱ组)30例,非黄疸患者。均采用全凭静脉麻醉,用4个成串刺激(train of four,TOF)进行肌肉松弛监测。顺式阿曲库铵首量为3×95%有效剂量(95% effective dose ofdrug,ED_(95))(0.15 mg/kg),当术中T_1恢复达5%时追加顺式阿曲库铵1×ED_(95)(0.05 mg/kg),连续5次,观察顺式阿曲库铵的起效时间、临床时效、术中5次追加顺式阿曲库铵临床有效作用时间、术毕恢复指数、4个成串刺激比值(train of four rate,TOFR)从0恢复至70%和从70%恢复至90%的时间以及拔管即刻的TOFR,同时监测血气分析。结果 2组T1最大抑制程度均为100%,Ⅰ组起效时间延长(P<0.05),其余药效学参数2组差异无统计学意义(P>0.05)。拔管时2组的TOFR值及TOFR<70%的例数差异无统计学意义(P>0.05)。术后2组均存在不同程度肌肉松弛残留情况,组间比较差异无统计学意义。结论梗阻性黄疸可导致顺式阿曲库铵起效时间延长,但恢复时间无变化,反复追加无蓄积,拔除气管内导管应在TOFR恢复达90%时为宜。

Objective To study the time - course effect and postoperative residual curarization of cisatracurium in patients with obstructive jaundice. Methods Sixty patients receiving elective surgery under general anesthesia were divided into 2 groups, trial group （ group I） included 30 American Society Anesthesiologists （ASA） I - In patients with obstructive jaundice and control group（ group 11 ）included 30 ASA I -III patients without obstructwe jaundice. All patients received total intravenous anesthesia with remifentanyl and propofol. Neuromuscular blockade was evaluated with train - of - four （TOF） stimuli of the ulnar nerve during operation. The 3 × ED95 （0.15 mg/kg） of cisatracurium was given during anesthesia induction. As TOF rate （TOFR） reached 5% , 1 × ED95 （0. 05mg/kg） of cisatracurium was added. Postoperation neuromuscular blockade was continuously evaluated until TOFR reached 90% . The onset time ,effect time of cisatracurium,the time of TOFR from 0 to 70% and from 70% to 90% ,and the TOFR at the time of tracheal extubation were observed. The blood gas analysis was done at the same time. Results The onset time in group I was longer than that in group II （P 〈 0.05 ）. The recovery time were similar in group I and II. The TOFR and the number of patients with their TOFR less than 70% were similiar in group I and 11 at the time of tracheal extubation. Similar degrees of postoperative residual curarization existed in 2 groups. Conclusion Obstructive jaundice may prolong the onset time of cisatracurium,but does not significantly affect the recovcry time of cisatracurium. No drug accumulation occurs after repeated superaddition and extubation should be done only when TOFR reached 90%.