七氟烷和地氟烷对老年患者罗库溴铵药效学的影响

Effects on pharmacodynamics of rocuronium in elderly patients using sevoflurane and desflurane

目的:观察吸入1.3MAC七氟烷和地氟烷40 min麻醉下对老年患者术中罗库溴铵药效动力学的影响。方法:全麻下行择期手术的老年患者90例,ASAⅠ~Ⅱ级。随机均分为6组,每组15例。七氟烷组(S1组和S2组)和地氟烷组(D1组和D2组)分别吸入1.3MAC七氟烷和地氟烷并维持40 min,对照组(P1组和P2组)血浆靶控输注丙泊酚3.5~4μg/m L维持同样时间。采用TOF-Watch SX肌松监测仪行拇内收肌肌松监测。S1组、D1组和P1组中心静注罗库溴铵75μg·kg^(-1)·次^(-1),总量0.3 mg/kg,并记录每次用药后T_1的最大阻滞效应,最终使T_1抑制超过95%。采用四次累积剂量的方法计算量效关系曲线和ED_(50)、ED_(90)、ED_(95)。S2组、D2组和P2组患者则分别中心静脉注射罗库溴铵0.6 mg/kg,记录罗库溴铵给药完毕至T_1消失时间(起效时间),T_1从0%恢复至5%所需时间(高峰时间)、T_1恢复至25%所需时间(临床肌松时间)、T_1从25%恢复至75%所需时间(恢复指数)、T_1恢复至70%所需时间(体内作用时间)以及TOFr恢复至70%和90%的时间。结果:D1组ED_(50)、ED_(90)和ED_(95)分别为74.23μg/kg、114.58μg/kg和130.12μg/kg,S1组ED_(50)、ED_(90)和ED_(95)分别为80.57μg/kg、125.04μg/kg和141.89μg/kg,P1组ED_(50)、ED_(90)和ED_(95)分别为110.61μg/kg、170.83μg/kg和194.16μg/kg。D1组和S1组的ED_(50)、ED_(90)和ED_(95)均显著低于P1组(P<0.05),而D1组和S1组之间则差异无显著性。D2组和S2组各作用时效指标均显著长于P2组(P<0.05);而D2组和S2组间比较,除D2组的高峰时间明显增加外,其他作用时效指标均无统计学差异。结论:1.3MAC地氟烷和七氟烷40 min麻醉下老年患者罗库溴铵的ED_(50)、ED_(95)显著降低,作用时间则明显延长,而对此改变,两种吸入麻醉药之间则无统计学差异。

AIM： To observe the intraoperative influences on pharmacodynamics of rocuronium in elderly patients inhaling 1. 3 MAC sevoflurane and desflurane for 40 min. METHODS： 90 elderly patients（ ASA Ⅰ- Ⅱ） undergoing elective surgery under general anesthesia were assigned randomly to six groups consisting of 15 patients each. 1. 3 MAC sevoflurane and desflurane were inhaled and maintained for 40 min respectively in the patients ofsevoflurane group（ group S1 and S2） and desflurane group（ group D1 and D2）. Plasma target controlled infusion of 3. 5- 4 μg / mL propofol was administered to patients of the control group（ group P1 and P2） for same amount of time. A TOF-Watch SX monitor was used to monitor the neuromuscular function of adductor pollicis muscle. Rocuronium（ 75 μg / kg per time） was injected through central vein with the method of cumulative dose of four times in group S1,D1 and P1. Maximum inhibited effect of T1 was recorded after every injection until inhibition of T1 reached more than 95% eventually. Efficiency curve and ED（50）,ED（90）,ED（95） were calculated at last. 0. 6mg / kg rocuronium was injected respectively through central vein of every patient in group S2,D2 and P2. Recorded the recovery times of muscle relaxant,which including time of T1disappearance（ onset time）,T1 from 0% to 5%（ peak effect time）,T1 from 0% to 25%（ clinical effect time）,T1 recovered from 25% to 75%（ recovery index）,T1from0% to 70%（ internal effect time）,TOFr from 0%to 70% and 90%. RESULTS： ED（50）,ED（90） and ED（95）of group D1 were 74. 23 μg / kg,114. 58 μg /kg and 130. 12 μg / kg respectively; ED（50）,ED（90） and ED（95）of group S1 were 80. 57 μg / kg,125. 04 μg / kg and 141. 89 μg / kg respectively; ED（50）,ED（90） and ED（95）of group P1 were 110. 61 μg / kg,170. 83 μg /kg and 194. 16 μg / kg respectively. ED（50）,ED（90） and ED（95）of group D1 and S1 were significantly lower than those of group P1（ P〈0. 05）,but there was no significant difference between D1 and S1 group.Except the peak effect time of group D2 which obviously increased,the other index of neuromuscular function had no significant difference between group D2 and S2. CONCLUSION： 1. 3 MAC sevoflurane and desflurane inhaled for 40 min significantly reduces the ED（50）,ED（95） of rocuronium,and prolongs the active time of rocuronium in elderly patients,but there is no difference between sevoflurane and desflurane regarding this effect.