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| 罗库溴铵在长寿老年患者和中年患者骨科手术中的药效学比较 |
| Comparison pharmacodynamics of rocuronium in longevity and middle-aged patients during orthopedic surgeryLI |
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| DOI：10.12089/jca.2019.03.003 |
| 中文关键词: 罗库溴铵 长寿老年患者 起效时间 性别 |
| 英文关键词: Rocuronium Longevity Onset time Gender |
| 基金项目: |
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| 摘要点击次数: 3075 |
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| 中文摘要: |
目的 观察罗库溴铵在长寿老年患者(≥90岁)和中年患者(45~59岁)单次和重复静脉注射的肌松效应。
方法 选择行下肢手术的长寿老年患者(≥90岁)12例和中年患者(45～59岁)12例，按性别再分为男6例，女6例, BMI 19.9~20.9 kg/m2，ASA Ⅱ 或 Ⅲ级。所有患者分为长寿老年男性患者组（LM组）、长寿老年女性患者组（LF组）、中年男性患者组（MM组）和中年女性患者组（MF组）。麻醉诱导以咪达唑仑0.02 mg/kg、舒芬太尼0.4 μg/kg、丙泊酚1.5~2.0 mg/kg静脉注射，其后在10 s内静脉注射罗库溴铵0.5 mg/kg，待四个成串刺激中第一个肌颤搐（T1）完全消失时行气管插管，麻醉维持以丙泊酚4~10 mg·kg-1·h-1静脉泵推注，间断静脉注射舒芬太尼，待T1恢复至对照值的25%时追加罗库溴铵0.1 mg/kg。记录首次静脉注射罗库溴铵的起效时间、无反应期时间和T1=25%恢复时间，记录3次追加罗库溴铵的无反应期时间和T1=25%恢复时间。
结果 LM组起效时间明显短于MM组(P<0.05)；LF组起效时间明显短于MF组(P<0.05)；LM组起效时间明显长于LF组(P<0.05)；MM组起效时间明显长于MF组(P<0.05)。与第1次追加时比较，第2、3次追加时四组无反应期时间和T1=25%恢复时间明显延长(P<0.05)，且第3次追加时明显长于第2次追加时(P<0.05)。不同时点LM组无反应期时间和T1=25%恢复时间明显长于MM组(P<0.05)；不同时点LF组无反应期时间和T1=25%恢复时间明显长于MF组(P<0.05)。不同时点LM组无反应期时间和T1=25%恢复时间明显短于LF组(P<0.05)，不同时点MM组无反应期时间和T1=25%恢复时间明显短于MF组(P<0.05)。
结论 罗库溴铵在长寿老年患者其起效时间较中年患者快，长寿老年女性患者起效时间最快；长寿老年患者其无反应期时间、T1=25%恢复时间较中年患者长，随着追加次数增多患者肌松作用时间均有逐渐延长的趋势，且女性患者较男性患者延长更明显。 |
| 英文摘要: |
Objective To investigate the effects of neuromuscular blockade produced by a loading dose followed by increments of rocuronium bromide in longevity patients (≥ 90 years) and middle - aged patients (45 - 59 years) .
Methods Longevity patients (n = 12, male 6, female 6), and middle - aged patients (n=12, male 6, female 6) with ASA Ⅱ or Ⅲ, BMI 19.9 - 20.9 kg/m2 , presenting for low extremity orthopedic surgery undergoing general anesthesia were studied. They were divided into four groups according to age and gender. Namely, the longevity male patients (group LM), the longevity female patients (group LF), the middle - aged male patients (group MM) and the middle - aged female patients (group MF). Anesthesia was induced with intravenous midazolam 0.02 mg/kg, propofol 1.5~2.0 mg/kg and sufentanyl 0.4 μg/kg and following a loading dose of rocuronium 0.5 mg/kg was given intravenously within 10 seconds. Endotracheal intubation was performed when the complete disappearance of the first twitch (T1) in the train of four stimuli. Anesthesia was maintained with propofol 4 - 10 mg·kg-1·h-1 by infusion pump, and intermittent intravenous boluses of sufentanyl. Muscle relaxation was maintained with increments of rocuronium 0.1 mg/kg when T1 returned to 25% of control. Onset time (time from end of injection to T1=0), no response time (duration of T1=0), time of 25% recovery of T1(time from end of injection to 25% recovery of T1) were recorded after first loading dose. No response time and the time of 25% recovery of T1 were recorded after the next two incremental doses.
Results Onset time was shorter in group LM than in group MM (P < 0.05).Onset time was shorter in group LF than in group MF (P < 0.05). Onset time was longer in group LM than in group LF (P < 0.05). Onset time was longer in group MM than in group MF (P < 0.05). No response time and time of 25% recovery of T1 were longer in the second dosage and third dosage than in the first dosage in all four groups respectively (P < 0.05). No response time and time of 25% recovery of T1 were longer in the third dosage than in the second dosage in all four groups (P < 0.05). No response time and time of 25% recovery of T1 were longer in group LM than in group MM at different time points (P < 0.05). No response time and time of 25% recovery of T1 were longer in group LF than in group MF at different time points (P < 0.05). No response time and time of 25% recovery of T1 were shorter in group LM than in group LF at different time points (P < 0.05). No response time and time of 25% recovery of T1 were shorter in group MM than in group MF at different time points (P < 0.05).
Conclusion Onset time was shorter in longevity patients than in middle - aged patients. Onset time was shortest in longevity female patients of all patients. No response time and time of 25% recovery of T1 were longer in longevity patients than in middle - aged patients. No response time and time of 25% recovery of T1 increased with increasing numbers of incremental doses. The duration time and action were longer in longevity patients than in middle - aged patients. The duration time was longer in female patients than in male patients. |
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