顺苯磺酸阿曲库铵用于肥胖患者的神经肌肉阻滞效应

Neuromuscular effects of cisatracurium besylate in obese patients

目的观察丙泊酚全静脉麻醉时肥胖患者按实际体质量给予顺苯磺酸阿曲库铵的神经肌肉阻滞效应。方法选择北京大学第一医院2012年7至12月择期全麻手术患者36例，美国麻醉学会体格分级（ASA）Ⅰ～Ⅱ级，年龄18～65岁，按照体质指数（BMI）将患者分为2组（n=18）：肥胖组（BMI〉28）和正常体质量组（BMI〈24）。2组患者以丙泊酚血浆靶浓度3μg／ml和瑞芬太尼效应室浓度3～5ng／ml靶控输注诱导，待患者意识消失后给予顺苯磺酸阿曲库铵0．2mg／kg。使用TOF-Watch SX肌松监测仪，采用单次颤搐刺激（频率0．1Hz，刺激持续时间0．2ms），测定刺激前臂尺神经拇内收肌的加速度。记录起效时间、肌颤搐最大抑制程度、临床作用时间、恢复指数和75％恢复时间。肌颤搐抑制达到最大抑制时行气管插管，机械通气，评价气管插管条件。结果肥胖组和正常体质量组平均起效时间分别为（164±25）、（201±48）S，差异有统计学意义（t=2．83，P〈0．05），临床作用时间分别为（68．4±9．6）、（62．0±6．5）min，差异有统计学意义（t=2．33，P〈0．05），恢复指数分别为（15．6±4．7）、（10．8±4．2）rain，差异有统计学意义（t=3．03，P〈0．05），75％恢复时间分别为（83．9±11．5）、（73．0±9．2）min，差异有统计学意义（t=2．94，P〈0．05）。2组患者气管插管条件优良率均为100％。结论和正常体质量组比较，肥胖患者按实际体质量给予0．2mg／kg顺苯磺酸阿曲库铵起效时间缩短，临床作用时间和恢复指数延长。

Objective To explore the neuromuscular effects of cisatracurium besylate in morbidly obese patients when dosed according to real body weight under total intravenous anesthesia with propofol. Methods Thirty-six ASA Ⅰ～Ⅱ patients aged 18 -65 years scheduled for elective procedures at our hospital during July 2012 to December 2012 were allocated into 2 groups according to body mass index （ normal weight ： body mass index ： 〈 24, overweight ： body mass index 〉 28 ）. Anesthesia was induced with target-controlled infusion of propofol （ Cp 3 pμg/ml ） and remifentanil （ Ce 3 - 5 ng/ml ） . A bolus of eisatracurium 0. 2 mg/kg was administered intravenously over 5 - 10 s as soon as a patient lost consciousness. Neuromuscular block was monitored with TOF-Watch SX （Oaganou, the Netherlands）. Single stimulation （0. 1 Hz ） was applied to ulnar nerve at wrist. The maximal degree of neuromuscular block, onset time, clinical duration and recovery index were recorded. They were intubated and mechanically ventilated when neuromuscular block reached the maximal degree. The intubation condition was evaluated. Results The average onset time was （ 164 ± 25 ） s in obese group versus （201 ± 48 ） s in normal weight group. And there was significant difference between groups （ t = 2. 83, P 〈 0. 05 ） . The clinical duration was （68.4 ± 9. 6 ） rain in obese group versus （62. 0 ± 6.5 ） rain in normal weight group. And there was significant difference between groups （t = 2. 33, P 〈 0. 05 ）. The recovery index was （ 15.6 ＋ 4. 7） rain in obese group versus （ 10. 8 ± 4. 2 ） min in normal weight group. And there was significant difference between groups （ t = 3.03, P 〈 0. 05 ）. Also 75% recovery time was （ 83.9 ± 11.5 ） rain in obese group versus （73.0 ± 9.2） min in normal weight group. And there was significant difference between groups （ t = 2. 94, P 〈 0. 05 ）. But no differences existed in intubation conditions. Conclusion When dosed according to real body weight, onset time of cisatracurium is shorter while clinical duration and recovery index are prolonged in morbidly obese patients compared with normal weight counterparts.