摘要
目的 观察罗库溴铵在肾功能正常和肾衰患者单次及重复静注的肌松效应。方法终末期肾衰行肾移植术的患者12例,ASAⅢ级,另以下腹部手术患者ASA Ⅰ-Ⅱ级12例为对照。麻醉诱导以咪达唑仑0.02 mg·kg-1、芬太尼1μg·kg-1、异丙酚1.5～2mg·kg-1静脉注射,其后在10s内静注罗库溴铵0.6 mg·kg-1,待T1完全消失时行气管插管,麻醉维持以吸入50％N2O-O2,间断静注芬太尼,待T1恢复至对照值的25％时追加罗库溴铵0.15 mg·kg-1。结果 诱导剂量的罗库溴铵对肾功能正常和肾衰患者起效时间、无反应时间和T1 25％恢复时间的差异无显著性。各次追加药之无反应时间和T1 25％恢复时间随追加次数增多有逐渐延长的趋势,相对应的时间女性比男性长。用新斯的明拮抗罗库溴铵明显缩短T1 75％恢复时间。结论 罗库溴铵在肾功能正常患者和肾衰患者的首次应用和维持追加作用时间差异无显著性;随追加次数增多,有作用逐渐延长趋势;女性比男性更明显。
Objective To investigate the neuromuscular blockade produced by a loading dose and increments of rocuronium bromide in patients with terminal stage renal failure. Methods Twelve ASA Ⅲ patients (7 male, 5 female) with terminal stage renal failure undergoing renal transplantation were studied. Age ranged from 20-48 years and body weight 48-70kg. Another twelve ASA Ⅰ -Ⅱ patients (6 male, 6 female) with normal renal function aged 21-50 yr, weighing 49-72 kg undergoing elective lower abdominal surgery were included in this study as control group. The patients were unpremedicated. Anesthesia was induced with midazolam 0.02 mg·kg-1 , fentanyl 1μg·kg-1 and propofol 1.5-2.0 mg·kg-1 . Intubation was facilitated with a loading dose of rocuronium 0.6mg·kg-1 given intravenously (iv) within 10 seconds. Anesthesia was maintained with 50% N2O in O2 and intennittent iv boluses of fentanyl. Muscle relaxation was maintained with increments of rocuronium 0.15 mg·kg-1 when T1 returned to 25% of control. Neuromuscular blockade was assessed with Myograph 2000. A train-of-four (TOF) stimulation was used to measure force of thumb adduction. The first twitch (T1 ) measured before rocuronium was used as control (Tc) and compared with T, after rocuronium (T1 / Tc). 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), time of 75% recovery and recovery index (T1 from 25%-75% ) were recorded after loading doses and incremental doses. At the end of surgery residual paralysis was reversed with neostigmine 2.5 mg and glycopyrrolate 0.5 mg in six patients in each group. Results There was no significant difference in onset time, no response time and time of 25 % recovery of T1 after loading dose between the two groups. No response time and time of 25 % recovery of T1 were increasing with increasing numbers of incremental doses. The duration of action was relatively longer in women than in men. Neostigmine significantly shortened the time of 75 % recovery of T1 . Conclusion There is no significant difference in the duration of action after loading dose or incremental dose between patients with normal renal function and terminal stage renal failure. The duration or action is increasing with increasing numbers of incremental dose. The duration of action is longer in women than in men.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2004年第1期7-9,共3页
Chinese Journal of Anesthesiology
关键词
罗库溴铵
肾功能
药效学
肌松效应
肾移植术
麻醉诱导
Androstanols
Renal failure
Neuromuscular blockade
Dose-response relationship,drug
