糖尿病因素对患者米库氯铵肌松效应的影响：量效和时效关系

Effect of diabetes mellitus factor on mivacurium-induced muscle relaxation： dose-response relationship and time-course

目的评价糖尿病因素对患者米库氯铵肌松效应的时效及量效关系的影响。方法择期全麻手术患者，性别不限，年龄40～64岁，体重指数20-25kg/m2，ASA分级Ⅰ或Ⅱ级，神经肌肉功能未见异常。根据是否并存2型糖尿病，将患者分为糖尿病组（D组，n=80）和非糖尿病组（ND组，n=80）。每组患者随机分为4个亚组（n=20），分别为D1、D2、D3、D4亚组和NDl、ND2、ND3、ND4亚组。分别静脉注射米库氯铵20、40、60和80μg／kg。麻醉诱导：依次静脉注射咪达唑仑、芬太尼及依托咪酯，患者意识消失后启动CLMRIS-1闭环肌松注射系统监测神经肌肉接头功能。静脉注射相应剂量的米库氯铵，注射时间为5s，达到最大肌松程度时行喉罩置入术，连接麻醉机行机械通气。靶控输注异丙酚和瑞芬太尼维持麻醉，维持BIS值40—60。记录各组最大肌松程度、起效时间（从注药毕至最大肌松程度的时间）、作用时间（最大肌松程度维持时间）、恢复时间（从作用时间末至T1恢复到90％的时间）。结果与ND组比较，D组ED95、ED75和ED50降低（P〈0．05），分别降低8．8％、9．2％和9．2％。与ND组相应亚组比较，D组（D1、D2、D3及D4亚组）米库氯铵的起效时间及恢复时间均明显延长（P〈0．05），起效时间延长程度分别为35％、36％、39％、40％；恢复时间延长程度分别为27％、24％、22％、23％。结论患者糖尿病因素可轻度增强米库氯铵肌松作用的效力，而显著延长其起效和恢复时间。

Objective To evaluate the effect of diabetes mellitus factor on the dose-response rela- tionship and time-course of muscle relaxation induced by mivacurium. Methods The patients of either sex, aged 40-64 yr, with body mass index of 20-25 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, with normal neuromuscular function, scheduled for elective surgery under general anesthesia, were enrolled in the study. The patients were divided into 2 groups depending on whether or not the patients suffered from the type 2 diabetes mellitus： diabetes mellitus group （ group D, n = 80） and non-diabetes mellitus group （group ND, n= 80）. The patients in either group were further divided into 4 subgroups （n=20 each） using a random number table： D1, D2, D3 and D4 subgroups or ND1, ND2, ND3 and ND4 subgroups in which mivacurium 20, 40, 60 and 80 μg/kg were intravenously injected, respectively. Anesthesia was induced with intravenous midazolam, fentanyl and etomidate in sequence. After loss of consciousness, the function of neuromuscular junction was monitored using the CLMRIS-1 closed loop system. The corresponding doses of mivacurium were injected intravenously over 5 s. When the maximum muscle relaxation was achieved, laryngeal mask airway was inserted, and the patients were mechani- cally ventilated. Anesthesia was maintained with target-controlled infusion of propofol and remifentanil, and bispectral index values were maintained at 40-60. The maximum muscle relaxation, onset time （time from the end of mivacurium injection to the maximum muscle relaxation）, duration of action （ time for maintenance of maximum muscle relaxation） and recovery time （from the end of action duration to T1 returned to 90%） were recorded. Results Compared with group ND, the EDs0, ED75 and ED95 of mivacurium were significantly decreased by 8.8%, 9.2% and 9.2% respectively in group D （P〈0.05）. Compared with the corresponding ND subgroups, the onset time was significantly prolonged by 35%, 36%, 39% and 40%, and the recovery time by 27%, 24%, 22% and 23% in D1, D2, D3 and D4 subgroups, respectively （P〈0.05）. Conclusion Diabetes mellitus factor can slightly enhance the potency of mivacurium-indueed muscle relaxation and obviously prolong the onset time and recovery time.