肝功能障碍患者对罗库溴铵药效动力学的影响

Influence of Hepatosis on the Pharmacodynamics of Rocuronium

目的：探讨不同肝功能分级患者对肌松药罗库溴铵药效动力学的影响。方法：纳入肝功能障碍的手术患者152例,根据肝功能Child-Pugh分级将其分为Child-Pugh A级组62例、Child-Pugh B级组55例、Child-Pugh C级组35例,同时纳入肝功能正常患者60例为对照组。以维库溴铵以动态靶控输注程序控制,0.15-0.2μg/m L之间,维持肌松水平T1/TC在25%以内。对比分析四组间一般情况（包括性别、年龄、体重和BMI指数）、麻醉起效时间、最大阻滞持续时间、T110%恢复时间、T125%恢复时间、T175%恢复时间、恢复指数。结果：Child-Pugh A、B、C组患者的麻醉起效时间逐渐延长,组间差异有统计学意义（P〈0.05）。Child-Pugh A、B、C三组间患者的麻醉最大阻滞程度逐渐下降,组间差异有统计学意义（P〈0.05）。Child-Pugh A、B、C三组间患者的麻醉恢复指数逐渐增大,组间差异有统计学意义（P〈0.05）。Child-Pugh A、B、C和对照组间T110%恢复时间、T125%恢复时间、T175%恢复时间无明显差异（P〉0.05）。Child-Pugh A级组女性麻醉起效时间明显快于男性,差异有统计学意义（P〈0.05）;男性最大阻滞持续时间小于女性,性别间差异有统计学意义（P〈0.05）。肝功能Child-Pugh B级组女性麻醉起效时间明显快于男性,差异有统计学意义（P〈0.05）。肝功能Child-Pugh C级组性别间麻醉起效时间、最大阻滞持续时间、恢复指数差异无统计学意义（P〉0.05）。结论：肝功能障碍明显影响肌松药罗库溴铵麻醉起效时间,重度肝功能患者使用罗库溴铵时可不考虑性别的影响因素。

Objective： To research the influence of rocuronium pharmacodynamics in patients with different degree of hepatosis.Methods： The 152 cases of patients with surgery were divided into three groups according to the Child-Pugh scores： group A（Child-Pugh A） with 62 cases, group B（Child-Pugh B） with 55 cases and group C（Child-Pugh C） with 35 cases. Meanwhile, 60 patients with normal liver function were included in this research as control group. Vecuronium bromide was injected with dynamic target control infusion procedure control, between 0.15-0.2 μg/m L, muscle relaxant T1/TC level maintained within 25%. General indexes including gender,age, weight and BMI, and the anesthesia onset time, maximum block anesthesia duration, T110% recovery time, T125% recovery time,T1 75 % recovery time, recovery index were analyzed and compared. Results： Anesthetic onset time extended gradually in A, B, C groups, and differences between them were statistically significant（P〈0.05）. The duration of block anesthesia in A, B, C groups gradually declined, and difference between them was statistically significant（P〈0.05）. Anesthesia recovery index in A, B, C groups increased gradually, and the difference between groups was statistically significant（P〈0.05）. T110 %, T125%, and T175 % % recovery time in group A, B, C, and the control group had no significant difference（P〉0.05）. In Child-Pugh class A group, the anesthesia onset time was obviously faster in women subgroup than in men subgroup, with statistically significant difference（P〈0.05）; and the block duration was longer in women subgroup than in men subgroup, also with statistically significant difference（P〈0.05）. In the Child-Pugh class B group, the anesthesia onset time was obviously faster in women subgroup than in men subgroup, and the difference was statistically significant（P〈0.05）. Yet, there were no statistical differences in onset time, maximum block anesthesia and recovery index between women and men in Child-Pugh C group（P〉0.05）. Conclusions： Hepatosis significantly affect the effect time of rocuronium. It could not consider the effect of gender when rocuronium is used for patients with severe liver disorders.