性别对结核病患者顺式阿曲库铵药效学参数的影响

The gender influence on the pharmacodynamic parameters of cis-atracurium in tuberculosis patients

目的探讨性别对结核病患者顺式阿曲库铵药效学参数的影响。方法择期行全身麻醉手术80例，结核病（T组）及非结核病（N组）患者40例，两组依性别不同分为结核病男性组（TM组）、女性组（TF组）及非结核病男性纽（NM组）、女性组（NF组），每组20例。所有患者入室后予静脉输注咪达唑仑0．1mg／kg、芬太尼4μ/kg，靶控输注丙泊酚1—4μg／mL，患者意识消失后采用4个成串刺激进行肌松监测，静脉注射顺式阿曲库铵0．15mg／kg，当第1个肌颤搐反应（T，）下降至最低值并连续重复3次以上时行气管插管，记录起效时间、T，最大抑制程度、临床作用时间、恢复指数、药理作用时间及气管插管条件和麻醉诱导前（t0）、给予肌松药后5rain（t1）、15min（t2）、30min（t3）、45min（t4）、1h（t5）时的平均动脉压和心率。结果与男性相比，T组女性起效时间较短，临床作用时间及药理作用时间较长（P〈0．01）；与N组相比，T组患者顺式阿曲库铵临床作用时间及药理作用时间较短，但组间差异无统计学意义（P〉0．05）。结论结核病患者顺式阿曲库铵单次静脉注射时女性较男性更敏感，表现为起效时间较短，临床作用时间及药理作用时间较长。

Objective To investigate the pharmacodynamic parameters of cis - atracurium in tuberculosis patients with different gender. Methods Eighty patients （ASA Ⅰ or Ⅱ ） received selective general anesthesia were enrolled in this study. They were divided into tuberculosis group （ Group T, n = 40） andnon - tuberculosis group （ Group N, n = 40）, whom were subsequently subdivided into male （TM and NM） and female （TF and NF） subgroups. All patients received an intravenous injection of midazolam （0. 1 mg/kg） , fentanyl （4 μg/kg） and propofol （with target plasma concentration of 1 -4 μg/mL）. The neuromuscular block level was measured by neuromuscular transmission monitor after patients＇consciousness disappeared. With an intravenous 0. 15 mg/kg of cis - atracurium, the responses were defined in terms of the percentages of maximum suppression at the first contraction （ T1） of the train - of - four of the adductor pollicis muscle. Endotracheal intubation was conducted when T1 fell to its lowest and repeated no less than 3 times. The onset time, the maximum inhibition of T1, the clinical effect time, the recovery index, the pharmacological effect time and the endotracheal intubation conditions were recorded. MAP and HR were measured before anesthesia induction （ to ）, and 5 min （ t1 ）, 15 min （ t2 ）, 30 min （ t3 ） , 45 min （ t4 ）, and 1 h （ t5 ） after general anesthesia. Results The onset time of cis - atracurium in Group TF was significant shorter than that in Group TM, with significantly longer clinical effect time （ P 〈 0. 01 ）. However, there was no significant difference between Group NM and NF （P 〉 0. 05）. Compared with Group N, the clinical effect time and pharmacological effect time in Group T were significantly shorter （ P 〈 0. 05 ） , while there was no significant difference in the onset time, the maximum inhibition of T1 , the clinical effect time, the recovery index, or the pharmacological effect time between the two groups （ P 〉 0. 05）. No significant difference was found in the endotracheal intubation conditions or hemodynamics before or after induction among the four subgroups （ P 〉 0. 05 ）. Conclusion Female tuberculosis patients are more sensitive to a single intravenous injection of cis - atracurium, presenting with shortened onset time, and lengthened clinical effect time and pharmacological effect time.