罗库溴铵应用于产科全麻快速诱导气管插管最佳剂量的研究

The optimal dose of rocuronium for rapid induction of endotracheal intubation in obstetric anesthesia

目的探讨罗库溴铵用于产科全麻快速诱导气管插管的最佳剂量,为临床合理用药提供参考。方法选择择期全麻下行剖宫产术的产妇23例(产妇组)及行腹腔镜术患者25例(非产妇组),用丙泊酚2 mg/kg诱导,按照序贯试验法设定单次注射罗库溴铵,产妇组起始剂量选择0.25 mg/kg(术前体重),非产妇组选择0.30 mg/kg,进行气管插管。用药后若插管条件不满意,下一例患者用药量增加0.05 mg/kg;若插管条件满意,则下一例患者用药量减少0.05 mg/kg。比较两组罗库溴铵气管插管的ED50、ED95。结果产妇组罗库溴铵气管插管的ED50和ED95分别为0.29 mg/kg和0.39 mg/kg;非产妇组罗库溴铵气管插管的ED50和ED95分别为0.33 mg/kg和0.43 mg/kg。产妇组ED50为非产妇组的87.88%;术前血清钙、总蛋白和白蛋白均低于非产妇组(P<0.05),术前体重指数高于非产妇组(P<0.05)。结论产妇罗库溴铵气管插管的ED50明显小于非产妇,可能与产妇血清钙、血清蛋白减少及体重指数增加有关。建议全麻剖宫产术中应适当减少罗库溴铵的用量,避免发生肌松残留作用。

Objective To search the optimal dose of rocuronium for rapid induction of endotracheal intubation in obstetric anesthesia,and thus to provide a reference for clinical practice.Methods Twenty-three parturients undergoing cesarean section received general anestheasia and 25 non-parturients undergoing laparoscopy received propofol 2 mg/kg and rocuronium for induction and intubation.An up-down sequential allocation method was used to estimate the ED50 and ED95of rocuronium.If the intubation conditions were dissatisfied,the dose of rocuronium for next patient was increased 0.05 mg/kg.If the intubation conditions were satisfied,the dose of rocuronium for next patient was reduced 0.05 mg/kg.ED50 and ED95were estimated by using probit regression analysis.Results The ED50 and ED95of rocuronium for parturient was 0.29 mg/kg and 0.39 mg/kg,respectively.The ED50 and ED95of rocuronium for non-parturient was 0.33 mg/kg and 0.43 mg/kg,respectively.The ED50 in the parturient group was 87.88% of that in the non-parturient group（P〈0.05）.The concentration of serum calcium and plasma total protein and albumin in the parturient group was lower than that in the nonparturient group（P〈0.05）.The preoperative body mass index in the parturient group was higher than that in the non-parturient group（P〈0.05）.Conclusion The intubation ED50 of rocuronium in parturients is much less than that of nonparturients.This may be related to decreases of serum calcium and protein,and increases of BMI in parturients.Therefore,less dosage should be used in parturients undergoing cesarean section during general anesthesia to prevent the residual effect of muscle reluctant.