上海交通大学学报（医学版）

›› 2013, Vol. 33 ›› Issue (3): 331-.doi: 10.3969/j.issn.1674-8115.2013.03.016

• 论著（临床研究） • 上一篇    下一篇

七氟醚对老年患者应用顺式阿曲库铵肌松效应的影响

胡 潇1, 闻大翔2, 杭燕南2   

  1. 1.复旦大学附属眼耳鼻喉科医院麻醉科, 上海 200031； 2.上海交通大学 医学院附属仁济医院麻醉科, 上海 200127
  • 出版日期:2013-03-28 发布日期:2013-03-29
  • 通讯作者: 闻大翔, 电子信箱: wdxrwj@gmail.com。
  • 作者简介:胡 潇（1984—）, 男, 住院医师, 硕士； 电子信箱: fibrescope@hotmail.com。

Effect of sevoflurane on neuromuscular blockade of cisatracurium in elderly

HU Xiao1, WEN Da-xiang2, HANG Yan-nan2   

  1. 1.Department of Anesthesiology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China； 2.Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
  • Online:2013-03-28 Published:2013-03-29

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摘要：

目的 观察老年患者在全身麻醉中使用七氟醚对顺式阿曲库铵肌松效应的影响。方法 40例行择期手术的患者，ASA Ⅰ～Ⅱ级，按年龄分为老年组（≥65岁）和中青年组（18~65岁），两组再随机分为七氟醚组和丙泊酚组，每组10例。麻醉诱导使用咪达唑仑、异丙酚、芬太尼和利多卡因喷雾剂，插管后七氟醚组吸入1.73%七氟醚，丙泊酚组每小时使用4～6 mg/kg丙泊酚静脉维持，30 min后静脉注射总量为50 μg/kg的顺式阿曲库铵（首次静脉注射20 μg/kg，剩余分三等分，分次注射），采用4个成串刺激刺激（TOF）引起4个肌颤搐(肌颤搐幅度T1、T2、T3、T4)进行肌松监测，记录每次注药后起效时间及最大阻滞效应，用累积剂量法建立剂量效应曲线，获得50%和95%有效剂量（ED50、ED95）数据；在最后一次注药后记录T1恢复到25%、75%和90%的时间（T125%、T175%和T190%）、TOF比值恢复到70%的时间（TOF70%）和恢复指数（RI）。结果 老年七氟醚组、老年丙泊酚组、中青年七氟醚组和中青年丙泊酚组的顺式阿曲库铵ED50分别为28.51、33.47、26.16和31.77 μg/kg，ED95分别为50.93、59.86、48.69和55.43 μg/kg。七氟醚组顺式阿曲库铵的ED50和ED95显著小于相同年龄段的丙泊酚组（P<0.05）；但相同麻醉情况下，老年组与中青年组ED50和ED95比较差异无统计学意义（P>0.05）。各组顺式阿曲库铵起效时间比较差异无统计学意义（P>0.05）。七氟醚组的RI长于同年龄段的丙泊酚组，老年组的RI长于同等麻醉条件下的中青年组（P<0.05）。老年七氟醚组T125%、T175%、T190%和TOF 70%显著长于其余各组（P<0.05），中青年七氟醚组T125%、T175%、T190%和TOF 70%显著长于中青年丙泊酚组（P<0.05）。结论 相对于全凭静脉麻醉，七氟醚吸入麻醉后，顺式阿曲库铵的ED50 和ED95明显减小，肌松药消退时间明显延长。在相同麻醉条件下，与中青年患者比较，老年患者使用肌松药的消退时间也明显延长。

关键词: 顺式阿曲库铵, 七氟醚, 剂量效应曲线, 丙泊酚

Abstract:

Objective To investigate the effect of sevoflurane on neuromuscular blockade of cisatracurium in general anesthesia in the elderly. Methods Forty patients with ASA Ⅰ-Ⅱ undergoing elective surgery were randomly divided into elderly group (aged no less than 65) and adult group (aged between 18 and 65), and each group was randomly divided into sevoflurane group and propofol group, with 10 patients in each group. Anaesthesia was induced with midazolam, propofol, fentanyl and lidocaine aerosol. After induction, sevoflurane groups were maintained with 1.73% sevoflurane, and propofol groups were with 4-6 mg/kg propofol per hour. Thirty minutes later, 50 μg/kg cisatracurium was administered (20 μg/kg for the first injection, 10 μg/kg for the next three injections). Four myopalmus (amplitudes T1, T2, T3 and T4) was induced by train-of-four (TOF) stimulation, and neuromuscular monitoring was conducted. The time of onset after drug administration and maximum block effect were recorded, cumulative dose-effect curves for cisatracurium were determined, and 50% and 95% effective doses (ED50 and ED95) were obtained. After the last drug administration, the duration of recovery to 25% T1, 75% T1 and 90% T1 (T125%, T175% and T190%), duration of recovery to 70% TOF (TOF70%) and recovery index (RI) were recorded. Results ED50 of cisatracurium in elderly sevoflurane group, elderly propofol group, adult sevoflurane group and adult propofol group were 28.51 μg/kg, 33.47 μg/kg, 26.16 μg/kg and 31.77 μg/kg respectively, and ED95 of cisatracurium in these groups were 50.93 μg/kg, 59.86 μg/kg, 48.69 μg/kg and 55.43 μg/kg respectively. ED50 and ED95 of cisatracurium in sevoflurane groups were significantly lower than those in corresponding propofol groups (P<0.05). However, ED50 and ED95 in elderly groups were not significantly different from those in adult groups under the same condition of anesthesia (P>0.05). There was no significant difference in the time of onset of cisatracurium among groups (P>0.05). RI in sevoflurane groups were longer than those in corresponding propofol groups, and RI in elderly groups were longer than those in adult groups under the same condition of anesthesia (P<0.05). T125%, T175%, T190% and TOF 70% in elderly sevoflurane group were significantly longer than those in the other groups (P<0.05), and T125%, T175%, T190% and TOF 70% in adult sevoflurane group were significantly longer than those in adult propofol group (P<0.05). Conclusion Compared with total intravenous anesthesia, ED50 and ED95 of cisatracurium is significantly reduced and duration of recovery from the block is significantly prolonged after anesthesia with sevoflurane inhalation. Under the same condition of anesthesia, elderly patients may experience much longer duration of recovery from the block than adult patients.

Key words: cisatracurium, sevoflurane, dose-effect curve, propofol