长期糖皮质激素用药对老年患者全麻手术中顺阿曲库铵肌松效应的影响

Effects of long-term glucocorticoid administration on neuromuscular block of cisatracurium in elderly patients undergoing general anesthesia

目的探讨长期糖皮质激素用药对老年全麻手术患者顺阿曲库铵肌松效应的影响。方法择期老年全麻手术患者40例,男28例,女12例,年龄≥65岁,BMI 18-22kg/m2,ASA分级Ⅱ或Ⅲ级,根据患者是否长期糖皮质激素用药分为两组（n=20）：对照组（非激素组,C组）和激素组（J组）。静脉注射咪达唑仑0.03mg/kg,面罩吸入8%七氟醚,氧流量为8L,每30s递减2%,直至4%,睫毛反射消失后,静脉注射顺阿曲库铵0.15mg/kg,经1min静脉注射瑞芬太尼2μg/kg,30s后停止吸入七氟醚,气管插管后行机械通气,靶控输注丙泊酚和瑞芬太尼维持麻醉,采用TOFWatch SX加速度仪监测肌松程度,记录顺阿曲库铵起效时间、肌颤搐最大抑制程度、临床作用时间、恢复指数。结果与C组比较,J组顺阿曲库铵起效时间明显延长,肌颤搐最大抑制程度明显降低,临床作用时间明显缩短,恢复指数明显减小（P〈0.05）。结论长期糖皮质激素用药可减弱老年全麻手术患者顺阿曲库铵肌松效应。

Objective To investigate the effects of long-term glucocorticoid administration on neuromuscular block of cisatracurium in elderly patients undergoing general anesthesia.Methods Forty ASA Ⅱ orⅢ patients,aged≥65yr,with BMI of 18-24kg/m2,scheduled for elective operation were studied.According to the history of using or not long-term glucocorticoid,patients were assigned into two groups（n=20each）：control group（group C）,glucocorticoid group（group J）.Midazolam 0.03mg/kg was injected,mask inhalation of 8% sevoflurane and flow rate of oxygen8 L,every 30 sdecline 2%,until the 4%.After the disappearance of eyelash reflex,cisatracurium0.15mg/kg was injected intravenously.After 1min intravenous injection of remifentanil 2g/kg and30 s after stop of sevoflurane inhalation anesthesia,endotracheal intubation for mechanical ventilation,target controlled infusion of propofol and remifentanil anesthesia,using TOF-Watch SX acceleromyography monitoring of muscle relaxation,and onset time,clinical duration and recovery index（for T1 to return from 25%to 75% of the control twitch）were recorded.Results Compared with group C,the onset time was significantly prolonged,clinical duration and recovery index were shortened in group J（P〈0.05）.Conclusion Long-term glucocorticoid admininstration could reduce the neuromuscular blocking effect of cisatracurium in elderly patients.