地氟醚七氟醚对糖尿病患者罗库溴铵肌松效应影响的比较

Effects of sevoflurane and desflurane on neuromuscular blockade induced by rocuronium in patients with diabetes mellitus

目的 比较地氟醚和七氟醚对糖尿病患者罗库溴铵肌松效应的影响.方法 择期2型糖尿病腹部手术患者60例,年龄45～64岁,ASA分级Ⅱ级,采用随机数字表法分为3组,每组20例：地氟醚组（DD组）、七氟醚组（SD组）和异丙酚组（PD组）.静脉注射咪达唑仑、异丙酚和芬太尼行麻醉诱导后启动肌松监测,3组分别用异丙酚、地氟醚和七氟醚维持麻醉.记录肌松维持时间和恢复指数.于静脉注射罗库溴铵后10、20、30、40、50、60、70、80、90、100、110、120 min时记录T1/T0比值及T4/T1比值[四个成串刺激（train-of-four stimulation, TOF）比值].结果 DD组和SD组患者罗库溴铵的维持时间[（61±17）,（60±18） min]、恢复指数[（36±12）,（35±10） min]之间差异无统计学意义（P＞0.05）,且均大于PD组（P＜0.05）.DD组、SD组患者静脉注射罗库溴铵后60～120 min时T1/T0比值和TOF比值差异无统计学意义（P＞0.05）,且均大于PD组（P＜0.05）.结论 地氟醚和七氟醚对糖尿病患者罗库溴铵肌松效应的影响差异无统计学意义.

Objective To compare the effects of sevoflurane and desflurane on neuromuscular blockade induced by rocuronium in patients with diabetes mellitus.Methods Sixty patients with diabetes mellitus, ASA Ⅱ and aged 45-64 y, scheduled for elective middle or lower abdominal surgery were included.All patients were randomly assigned to one of three groups （n=20）： sevoflurane group （group SD）, propofol group （group PD）, and desflurane group （group DD）.All patients were induced with midazolam, propofol and fentanyl.Anesthesia was maintained with propofol infusion, sevoflurane, or desflurane inhalation, respectively.Neuromuscular function was assessed by accelerography.Train-of-four stimulation （TOF） of ulnar nerve was used.The duration of action and recovery index （for T1 to return from 25% to 75% of the control twitch） were recorded.The T1/T0 and TOF （T4/T1） ratios were recorded at 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120 min after a single bolus of rocuronium.Results There was no significant difference in duration of action and the recovery index between group DD[（61± 17）, （36±12） min] and group SD [（60±18）, （35±10） min]（P〉0.05）.The ratios of T1/T0 and TOF were not significantly different in group DD and group SD during 60 min to 120 min after a single bolus of rocuronium （P〉0.05）.Conclusions The effects of sevoflurane and desflurane on rocuronium induced neuromuscular blockade is similar in diabetic patients.