顺阿曲库铵用于阻塞性黄疸患者肌松效应及安全性

Neuromuscular blockade of cisatracurium in obstructive jaundice patients with liver dysfunction

目的观察不同程度阻塞性黄疸患者全身麻醉时顺阿曲库铵的肌松效应及安全性。方法选择ASA分级成年择期阻塞性黄疸手术患者40例,其中Child-Pugh A级(Ⅰ组)和Child-Pugh B级(Ⅱ组)各20例(n=20);同期肝功能正常行腹部手术患者(对照组)20例(n=20)。所有患者均采用异丙酚联合瑞芬太尼全凭静脉麻醉,顺阿曲库铵诱导量为3×ED_(95)(0.15 mg/kg),术中采用TOF-watch SX加速度仪对前臂尺神经行4个成串(TOF)刺激来评估神经-肌肉阻滞程度。观察麻醉诱导后肌松药起效时间、临床作用时间、恢复时间、恢复指数,评估插管条件,观察术中相关不良反应发生情况。结果Ⅰ组、Ⅱ组丙氨酸转移酶(ALT)及血总胆红素(TBIL)高于对照组(P<0.05或0.01),Ⅱ组ALT及TBIL高于Ⅰ组(P<0.05),Ⅰ组、Ⅱ组白蛋白水平均低于对照组(P<0.05)。与对照组相比,Ⅱ组患者顺阿曲库铵的起效时间延长(P<0.05),临床作用时间有延长趋势,但差异无统计学意义(P>0.05)。与对照组相比,Ⅰ组患者的起效时间、临床作用时间、恢复时间、恢复指数差异无统计学意义(P>0.05)。与Ⅰ组患者相比,Ⅱ组患者起效时间、临床作用时间有延长趋势,但差异无统计学意义(P>0.05),2组间恢复时间、恢复指数差异无统计学意义(P>0.05)。麻醉期间患者均未出现组胺释放的不良反应。结论顺阿曲库铵可以安全地用于阻塞性黄疸的患者,但应加强术中的肌松监测。

Objective To observe the different degree of general anesthesia in patients with obstructive jaundice cis muscle relaxant effect and safety of atracurium.Methods 40 patients with obstructive jaundice surgery were selected,in which the Child-Pugh,grade A（Ⅰ group） and Child-Pugh,class B（Ⅱ group） 20 cases（n=20）.Liver function was normal over the same line of abdominal surgery patients（control group） 20 cases（n=20）.All of the patients were given propofol combined fentanyl with intravenous anesthesia,cis atracurium induction of 3×ED95（0.15 mg/kg）,in the TOF-watch SX accelerometer of forearm ulnar nerve line four string（TOF） to stimulate the assessing the extent of the nerve-muscle block.Muscle relaxant effects were observed after anesthesia,induction time,clinical effects,recovery time and recovery index,assess intubation conditions,and some related adverse reactions were explored.Results Blood alanine transaminase（ALT） and total bilirubin（TBIL） of groupⅠ,Ⅱwere higher than that of control group（P〈0.05 or 0.01）,ALT and TBIL of groupⅡwere higher than that of groupⅠ（P〈0.05）,the albumin levels of groupⅠand Ⅱ were lower than that of group control（P〉0.05）.Compared with the control group,cis atracurium effects of group 2 were prolonged（P〈0.05）,the working effects of time in clinical practice were inclined to extend,but there was no statistically significant difference（P〉0.05）.Compared with control group,work time,clinical effects,recovery time and recovery index differencein patients of groupⅠhas no statistical significance（P〈0.05）.Compared with groupⅠ,work time,clinical effect time of group Ⅱhad a tendency to extend,but there was no statistical difference（P〈0.05）.The recovery time,recovery index difference between the two groups has no statistical significance（P〉0.05）.There was no histamine release and adverse reactions during the period of anesthesia.Conclusion Cisatracurium can be safely used in patients with obstructive jaundice,but the muscle relaxant monitoring should be strengthened.