摘要
目的 研究营养不良对罗库溴铵肌松作用的影响。方法 选择 ASA I-Ⅱ级全麻行择期手术的病人48例,按体重指数将病人分为4组:I组为正常对照组、Ⅱ组为轻度营养不良组、Ⅲ组为中度营养不良组、Ⅳ组为重度营养不良组。用肌松监测仪监测四个成串刺激（TOF）的变化,记录罗库溴铵插管剂量（0.6mg·kg-1）和维持剂量（0.15 mg·kg-1）的肌松指标。结果 插管剂量的罗库溴铵,在Ⅲ组和Ⅳ组的起效时间延迟[（184.7±58.1）s和（251.8±62.1）s,P<0.05],在Ⅳ组的T1最大抑制程度下降为95.17％±3.88％（P<0.05）,在Ⅲ组和Ⅳ组的时效缩短为（26.4±6.3）min和（25.0±7.1）min（P<0.05）。维持剂量的罗库溴铵,在Ⅲ组和Ⅳ组的时效缩短为（18.8±4.0）min和（17.0±4.2）min（P<0.05）。恢复指数在各组间无差别（P>0.05）,Ⅱ组的各指标与Ⅰ组比较无统计学差异（P>0.05）。结论 按实际体重给药,罗库溴铵在中度和重度营养不良病人身上的肌松作用减弱。
Objective It has been reported that nutritional status of the patients affects neuromuscular (N-M) blockade induced by succinylcholine, tubocurarine, atracurium and vecuronium. The purpose of this study was to investigate the effect of malnutrition on rocuronium induced N-M block. Methods Forty ASA Ⅰ -Ⅱ patients undergoing surgery under general anesthesia were divided into four groups of 12 patients each, based on body mass index (BMI): I normal group BMI = 18.5-25kg· m-2 ;Ⅱ mild malnutrition group BMI= 17-18.5 kg·m-2 ;Ⅲ moderate malnutrition groups BMI = 16-17 kg·m-2 and Ⅳ severe malnutrition group BMK<16 kg·m-2 .N-M blockade was monitored using TOF technique. Anesthesia was induced with fentanyl 4-5μg ·kg-1 and etomidate 0. 3mg·kg-1 . When the patient was asleep rocuronium 0.6 mg·kg-1 was given iv in 5 s following establishment of control twitch parameters. When the depression of T1 was >90% the patient was intubated and mechanically ventilated. PETCO2 was maintained at 4.0-4.7kPa. Anesthesia was maintained with 0.5%-0.7% isoflurane +60% N2O. During operation when T1 returned to 25% of control rocuronium 0.15mg·kg-1 was supplemented. The onset time, degree of N-M block and duration of action of initial and supplemental dose were recorded.Results With initial dose the onset time was delayed in group Ⅲ [(184±58)s] and group Ⅳ [(252±62) s] as compared with that in group Ⅰ [(122±33 )s] (P<0.05); the maximal depression of T1 was less in groupⅣ(95.17%±3.88%) than that in group Ⅰ(98.83% ±0.39% ) (P<0.05); the duration of action was shorter in group Ⅲ[(26± 6) min] and Ⅳ [(25 ± 7) min] than that in group Ⅰ[ (37 ± 9) min] (P<0.05) . With supplemental dose the duration of action was shorter in group Ⅲ [ (19 ±4) min] and Ⅳ [(17±4) min] than that in groupⅠ [(25 ± 6 min) ](P < 0.05) . There was no difference in recovery from N-M block between the groups (P>0.05) .Conclusions The neuromuscular blockade induced by rocuronium is reduced in patients with moderate and severe malnutrition.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2002年第5期269-272,共4页
Chinese Journal of Anesthesiology
