老年人按体质量给药罗库溴铵ED95测定及药效学研究

Determination of ED95 and pharmacodynamics of rocuroniumin elderly patients administrated according to body mass

目的研究老年人罗库溴铵(rocuronium,ROC)按体质量给药的剂量时效关系,计算其95%的有效剂量(ED95),并观察2×ED95诱导剂量的药效学参数。方法择期手术全身麻醉患者130例,年龄66~80岁,ASAⅠ~Ⅲ级。其中100例采用单次剂量法按体质量计算ROC ED95剂量,根据剂量不同随机分为5组:M1组(每kg体质量100μg,100μg/kg)、M2组(140μg/kg)、M3组(180μg/kg)、M4组(220μg/kg)、M5组(260μg/kg),每组20例。采用VERYARK-TOF监测单个肌颤搐反应(SS)最大抑制百分率并进行概率单位转换,ROC剂量进行对数转换,用直线回归法绘制其剂量时效曲线,计算出ROC ED95值。另外30例(C组)患者观察2×ED95诱导剂量的药效学参数。结果患者的一般情况差异无统计学意义(P> 0.05);各剂量组间SS最大抑制百分率差异有统计学意义(P <0.01);ROC按体质量给药的ED95为274μg/kg;C组按体质量2×ED95诱导剂量给药ROC起效时间为(88±26)s,最大抑制程度100%;最大效应持续时间(29.5±7.7)min;临床作用时间(44.3±7.6)min;恢复指数(18.8±4.3)min。结论采用单次剂量法测得老年人ROC按体质量给药的ED95为274μg/kg;按体质量2×ED95诱导剂量进行诱导的老年患者药效动力学参数除最大效能持续时间、临床作用时间明显延长外,其他与年轻成年患者基本一致。

Objective To study the dose-effect relationship of rocuronium bromide(ROC)administered by the body weight of the elderly,calculate its 95% effective dose(ED95),and observe the pharmacodynamic parameters of the 2× ED95 induced dose. Methods One hundred patients(aged 66~80 years,ASA grade Ⅰ to Ⅲ)out of 130 patients undergoing elective general anesthesia,were selected to measure the dose of ED95 administered according to body weight. The single-dose method was used to calculate the ROC ED95 dose according to body weight,and the patients were randomized to receive 100 μg per kg body weight,100 μg/kg(M1 group),140 μg/kg(M2 group),and 180 μg/kg(M3 group),220 μg/kg(M4 group),260 μg/kg(M5 group)respectively,with 20 cases in each group. VERYARK-TOF was used to monitor the maximum inhibition percentage of single muscle twitch response(SS)and perform probability unit conversion. Logarithmic conversion of ROC dose was performed. The doseeffect curve was plotted by linear regression method to calculate the ROC ED95 value;the remaining 30 cases(group C)patients were observed for the pharmacodynamic parameters of 2×ED95 induction dose. Results There was no statistically significant difference in the general condition of the patients(P > 0.05);the maximum SS inhibition difference was statistically significant among different dose groups(P < 0.01);the ED95 administered by ROC according to body weight was 274 μg/kg;In group C,the effective time of ROC administration was(88 ± 26)s and the maximum degree of inhibition was 100%;the maximum effect duration was(29.5 ± 7.7)min;the clinical effect time was(44.3 ± 7.6)min;the recovery index was(18.8 ± 4.3)min. Conclusions With single dose method,ED95 administered by the ROC of the elderly at a body mass of 274 μg/kg;the pharmacodynamic parameters of the elderly patients who were induced at a body mass of 2×ED95 induction dose were divided by the maximum efficacy duration and clinical effect time is significantly longer,and the others are basically consistent with young adult patients.