长期糖皮质激素用药对老年全麻手术患者维库溴铵肌松效应的影响

The Effect of Long-term Glucocorticoid Admininstration on Neuromuscular Block of Vecuronium in Elderly Patients Undergoing Operation

目的:探讨长期糖皮质激素用药对老年全麻手术患者维库溴铵肌松效应的影响。方法:择期老年全麻手术患者60例,性别不限,年龄≥65岁,BMI 18~22 kg/m^2,ASA分级Ⅱ~Ⅲ级,根据患者是否长期糖皮质激素用药分为对照组(非激素组,C组)和激素组(J组),各30例。静脉注射咪达唑仑0.03 mg/kg,面罩吸入8%七氟醚,氧流量为8 L,每30 s递减2%,直至4%,睫毛反射消失后,静脉注射维库溴铵0.15 mg/kg,经1 min静脉注射瑞芬太尼2μg/kg,30 s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TOF-Watch SX加速度仪监测肌松程度,记录维库溴铵起效时间、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组维库溴铵起效时间延长,肌颤搐最大抑制程度降低,临床作用时间缩短,恢复指数减小,差异均有统计学意义(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维库溴铵肌松效应。

Objective：To investigate the effect of long-term glucocorticoid admininstration on neuromuscular block of vecuronium in elderly patients undergoing operation.Method：60 elderly patients undergoing elective surgery under general anesthesia,male or female,aged ≥65 years,BMI 18~22 kg/m2,ASA gradeⅡ-Ⅲ,according to whether the patient’s long-term glucocorticoid treatment,patients were divided into the control group （non hormone group,C group） and hormone group （J group）,each of 30 cases.Intravenous injection of Midazolam 0.03 mg/kg,inhaled 8% Sevoflurane,Oxygen flow rate of 8 L,per 30 s decline of 2%,until 4%, after the eyelash reflex disappeared,intravenous injection of Vecuronium 0.15 mg/kg,1 min after intravenous injection of Remifentanil 2 g/kg,and 30 s after Sevoflurane stop,tracheal intubation after mechanical ventilation, target controlled infusion of Propofol and Remifentanil anesthesia.Used TOF-Watch SX acceleration to monitor the degree of muscle relaxation,recorded the onset time of vecuronium,twitch the maximal degree,clinical duration, recovery index.Result：Compared with group C,the onset time of vecuronium group J prolonged,muscle twitch maximal inhibition decreased and shorten the clinical action time,recovery index decreased,the differences were statistically significant（P〈0.05）.Conclusion：The effect of long-term glucocorticoid admininstration on neuromuscular block of vecuronium is enduced in elderly patients undergoing operation.