不同剂量顺阿曲库铵在老年患者与非老年患者麻醉诱导中的药效学比较

Pharmacodynamic comparison of different doses of cisatracurium in anesthesia induction between elderly patients and non-elderly patients

目的比较不同剂量顺阿曲库铵在老年患者与非老年患者麻醉诱导中的药效学变化。方法选取2020年1月至2020年2月于宝鸡市中心医院择期行全麻手术的80例患者,分为老年组(年龄≥60岁)和非老年组(年龄<60岁),每组40例。两组按静注顺阿曲库铵剂量分为0.10 mg/kg(2×ED95)、0.15 mg/kg(3×ED95)、0.20 mg/kg(4×ED95)和0.40 mg/kg(8×ED95)四个剂量组,每组10例。采用T1模式监测肌松,观察各组T1达90%抑制的时间和T1达最大抑制的时间,并比较各组气管插管条件。结果随着剂量增大,不同剂量组间顺式阿曲库铵起效时间明显缩短。静注顺式阿曲库铵剂量为0.10、0.15、0.20 mg/kg时,老年组T1达90%抑制的时间和T1达最大抑制的时间均长于非老年组(P<0.05);静注顺式阿曲库铵剂量为0.40 mg/kg时,老年组与非老年组T1达90%抑制的时间和T1达最大抑制的时间比较,差异无统计学意义(P>0.05)。气管插管条件评价结果显示,顺式阿曲库铵剂量为0.20 mg/kg时,老年组中有5例为优良,非老年组中均为优良,差异有统计学意义(P<0.05)。结论在全身麻醉诱导中,与非老年患者比较,增龄对顺阿曲库铵的药效影响显著;当给药剂量达到0.40 mg/kg(8×ED95)时,年龄对顺阿曲库铵的药效无明显影响。

Objective To compare the pharmacodynamic changes of different doses of cisatracurium in anesthesia induction between elderly patients and non-elderly patients. Methods From January 2020 to February 2020, 80 patients undergoing elective general anesthesia in Baoji central hospital were selected and divided into elderly group(age ≥ 60 years) and non-elderly group(age < 60 years), with 40 cases in each group. According to the dose of intravenous cisatracurium, the two groups were divided into four dose groups: 0.10 mg/kg(2 ×ED95), 0.15 mg/kg(3×ED95), 0.20 mg/kg(4×ED95) and 0.40 mg/kg(8×ED95), with 10 cases in each group. T1 mode was used to monitor muscle relaxation, and the time of T1 reaching 90% inhibition and the time of T1 reaching maximum inhibition were observed, and the conditions of tracheal intubation in each group were compared. Results With the increase of dose, the onset time of cisatracurium in the different dose groups was significantly shortened. When the dose of intravenous cisatracurium was 0.10, 0.15 and0.20 mg/kg, the time of T1 reaching 90% inhibition and the time of T1 reaching maximum inhibition in the elderly group were longer than those in the non-elderly group(P<0.05);when the dose of intravenous cisatracurium was 0.40 mg/kg,there were no significant differences in the time of T1 reaching 90% inhibition and the time of T1 reaching maximum inhibition between the elderly group and the non-elderly group(P>0.05). The evaluation results of conditions of tracheal intubation showed that when the dose of cisatracurium was 0.20 mg/kg, 5 cases in the elderly group were excellent and good, and all patients were excellent and good in the non-elderly group, and the difference was statistically significant(P<0.05). Conclusion In the induction of general anesthesia, compared with non-elderly patients, aging has a significant effect on the efficacy of cisatracurium;when the dosage reaches 0.40 mg/kg(8×ED95), age has no significant effect on the pesticide effect of cisatracurium.