罗库溴铵用于肝胆疾患病人的肌松效应

Pharmacodynamics of rocuronium bromide in patients with hepatobiliary disease

目的 观察罗库溴铵用于肝胆疾患病人的药效特点。方法 选择择期腹腔内手术的肝硬化病人(A组)、阻塞性黄疸病人(B1组)、胆汁淤积无黄疸病人(B2组)、肝功能正常病人(C组)各12例。观察全静脉麻醉下罗库溴铵起效时间、最大抑制程度、诱导剂量的临床作用时间、重复追加维持剂量的临床作用时间及术毕恢复指数。结果 A组起效时间明显延长(P<0.05),其中5例T1最大抑制程度未达100％。重复追加维持剂量罗库溴铵后A组、B1组临床作用时间呈逐渐延长趋势,重复追加4次以上更趋显著(P<0.05),两组间比较无统计学意义。B2组重复追加剂量后临床作用时间亦渐趋延长。术毕恢复指数A组较C组延长(P<0.01),B1组及B2组恢复指数与C组相比均有统计学意义(P<0.05)。结论 罗库溴铵用于肝硬化病人,存在初始剂量“阻抗”现象,反复用药有蓄积作用,阻塞性黄疸病人反复用药有蓄积作用,胆汁淤积病人反复用药也有蓄积的趋势和恢复时间延长。

Objective To investigate the characteristics of the pharmacodynamics of rocuronium bromide in patients with hepatobiliary disease. Methods Forty-eight patients undergoing abdominal surgery were divided into four groups, group A: patients with liver cirrhosis and portal hypertension (n = 12); group B1 : patients with cholelithiasis and obstructive jaundice (n = 12); group B2 : patients with cholelithiasis but no obstructive jaundice ( n=12);group C: patients without hepatobiliary disease ( n = 12) . Their renal function was normal. Patients with cardiovascular and neurological diseases were excluded. Premedication consisted of intramuscular phenobarbital 0.1 g and scopolamine 0.3 mg. Anesthesia was induced with midazolam 0.05 mg·kg-1 , fentanyl 2μg·kg-1 , propofol 2 mg·kg-1 and rocuronium 0.6 mg·kg-1 . The patients were intubated and mechanically ventilated. PETCO2 was maintained at 30-35 mm Hg. Anesthesia was maintained with iv infusion of propofol and fentanyl. Additional bolus dose of rocuronium 0.15 mg·kg-1 was given when T, recovered to 25% and each patient received six additional doses irrespective of duration of operation. Neuromuscular function was monitored using Datex-Ohmeda NMT mechanosensor. Onset time (from the end of injection to maximum depression of muscle twitch), clinical duration of intubating and additional dose (25 % recovery of T1 ) and recovery index (T1 from 25 % -75 %) were recorded. Results The demographic data were comparable among the four groups. The onset time was significantly longer in group A than that in group B, , B2 and C ( P < 0.05). There was no significant difference in the clinical duration of intubating dose among the four groups. The clinical duration of the additional doses in group A and B1 was progressively prolonged and was significantly prolonged after the 4 th additional dose ( P < 0.05). The recovery index in group A, B1 and B2 was significantly longer than that in control group (group C). (P < 0.05 or 0.01) Conclusion Patients with liver cirrhosis are 'resistant' to initial dose of rocuronium with longer onset time. Clinical duration after repeated doses and recovery index are significantly longer in patients with liver cirrhosis and obstructive jaundice.