近日节律对维库溴铵肌松作用的影响

The effect of circadian rhythm on the duration of neuromuscular blockade produced by vecuronium

目的探讨近日节律对维库溴铵肌松作用的影响。方法选取全麻手术患者80例,年龄18~55岁,体重指数18~24 kg/m2,ASA分级为I~Ⅱ级。根据患者手术时间分为日间组（07∶01~19∶00）和夜间组（19∶01~07∶00）,静脉注射丙泊酚、芬太尼行麻醉诱导,患者意识消失后静脉注射维库溴铵1 mg/kg;采用肌松监测仪监测拇内收肌阻滞情况。记录维库溴铵起效时间、T1最大效应持续时间、肌松作用时间。结果共有68例患者完成观察,其中日间组38例,男18例、女20例,平均年龄（34±7）岁,平均BMI为（20±3）kg/m2;夜间组30例,男14例、女16例,平均年龄（38±6）岁,平均BMI为（19±2）kg/m2。两组患者的性别构成、平均年龄、平均BMI等资料差异无统计学意义（P〉0.05）。与日间组比较,夜间组的肌松起效时间短、T1最大效应持续时间和肌松作用时间延长,差异有统计学意义（P〉0.05）。结论近日节律可影响维库溴铵的肌松作用时间,表现为夜间肌松起效快、肌松作用时间长于日间。

Objective To investigate the effect of circadian rhythm on the duration of neuromuscular blockade produced by veeuronium. Methods Seventy ASA Ⅰ or Ⅱ patients aged 18~55 yr with body mass on index of 18~24 kg/m2 undergoing general anesthesia were enrolled in this study. Anesthesia was induced with fentanyl and propofol. Vencuonrium 1 mg/kg was injected iv as soon as the patients lost consciousness, NBM was assessed by TOF-stimulation of ulnar nerve using TOF-Watch SX. Tracheal intubation was performed as soon as the first twitch disappeared. The patients were mechanically ventilation. Anesthesia was maintained with continuous infusion of propofol and remifentail. Anesthsia was performed at 2 time periods： 07 ： 01-19： 00and 19 ： 01-07 ： 00. Results There was 38 and 30 patients in day time and nighet-time groups respectively. The onset of vercirum was shorter and the duration of NMB was longer during night time than during day time. Conclusion Circadian rhythm can effect the onset and the duration of NMB elicited by vecuronium,which shows that the duration of NMB is longer during night-time than during day-time.