老年患者不同靶浓度罗库溴铵肌松效应的比较  

Neuromuscular blockade induced by different target concentrations of rocuronium given by TCI in the elderly

作　　者：张卫[1] 张凯[1] 阚全程[2] 彭周全[1] 刘新生[1] 樊肖冲[1] 

机构地区：[1]郑州大学第一附属医院麻醉科,450001 [2]郑州大学第一附属医院临床药理基地

出　　处：《中华麻醉学杂志》2007年第12期1071-1074,共4页Chinese Journal of Anesthesiology

摘　　要：目的比较老年患者不同靶浓度罗库溴铵的肌松效应。方法择期全麻老年患者100例,ASAⅡ级,随机分为4组（n=25）,A组、B组和C组麻醉诱导气管插管时效应室靶浓度（Ce）为3μg/ ml,术中维持Ce分别为0.6、0.8、1.0μg/ml;D组麻醉诱导气管插管时Ce为3.3μg/ml,术中维持Ce为0.8μg/ml。记录肌松起效时间、恢复时间和恢复指数。评价气管插管条件和术中肌松程度。记录手术及TCI时间、罗库溴铵总用药量和期间用药量[总用药量,（体重×TCI时间）]。结果4组均可顺利完成气管插管,D组起效时间较A组、B组和C组缩短（P〈0.05）;A组肌松满意率低,B组、C组和D组均可维持满意肌松,但C组罗库溴铵用量较多,术中肌松程度较大,术后恢复时间较长（P〈0.05）。结论麻醉诱导气管插管时罗库溴铵Ce为3.3μg/ml、术中麻醉维持Ce为0.8μg/ml,可产生满意的肌松条件,且有利于术后肌松恢复,是一种适用于老年患者合理的TCI给药方案。Objective To compare the neuro-muscular blockade induced by different target concentrations of target controlled infusion （TCI） of rocuronium in the elderly.Methods One hundred ASAⅡpatients aged 65- 80yr undergoing elective operation under general anesthesia were included in this study.The patients were unpremedicated.ECG,BP,SpO2 were continuously monitored.Neuro-muscular block was monitored by recording the force of contraction of the adductor pollicis after TOF stimulation of ulnar nerve using TOF GUARD acceleromyography （Organon,the Netherlands）.Anesthesia was induced with midazolam 0.1 mg/kg and fentanyl 5μg/kg. TCI of rocuronium was started to facilitate tracheal intubation as soon as the patients lost consciousness.The patients were randomly divided into 4 groups （n=25 each）：group A,B,C and D.In group A,B and C the target effect-site concentration （Ce） was set at 3μg/ml.Tracheal intubation was performed when T1 was reduced to〈5% of the control twitch （Tc） （T1/Tc〈5%）.After intubation the Ce was reduced to 0.6 （group A）,0.8 （B） and 1.0μg/ml （C） respectively during operation.In group D Ce was set at 3.3μg/ml during induction and at 0.8μg/ml during operation.The onset time （time from the beginning of TCI of rocuronium to T1=5% of control twitch）,recovery time （T1 has returned to 25% of the control twitch）,recovery index （the time for T1 to return from 25%-75% of control twitch）,intubation conditions and degree of muscle relaxation during operation and the total amount of rocuronium consumed during operation were recorded.Results Tracheal intubation was performed successfully in the 4 groups.Onset time in group D was significantly faster than that in the other three groups （P〈0.05）.Neuro-muscular block during operation was satisfactory in group B,C and D.Less amount of rocuronium was consumed,muscle relaxation during operation was better and recovery time shorter in group D than in group A,B and C （P〈0.05）.Conclusion The target effect-site

关 键 词：雄甾烷醇类 神经肌肉阻滞 药物释放系统 老年人 

分 类 号：R686[医药卫生—骨科学]