术前急性高容量血液稀释对罗库溴铵量-效关系的影响  

Influence of preoperative acute hypervolaemic haemodilution on the dose-response relationship of rocuronium

作　　者：周桥灵[1] 杨承祥[1] 樊友凌[2] 李恒[1] 刘洪珍[1] 

机构地区：[1]中山大学附属佛山医院麻醉科,528000 [2]徐州医学院 江苏省麻醉医学研究所&江苏省麻醉学重点实验室

出　　处：《国际麻醉学与复苏杂志》2009年第4期297-300,共4页International Journal of Anesthesiology and Resuscitation

摘　　要：目的观测急性高容量血液稀释（acute hypervolaemic haemodilution，AHHD）对罗库溴铵量嗷关系的影响。方法随机选择ASAI或Ⅱ级行腹腔镜腹部手术患者40例随机分为对照组（C组）和急性高容量血液稀释组（A组），每组20例。在麻醉诱导后、手术开始前A组采用6％羟乙基淀粉注射液（15ml／kg）行AHHD，以加速度仪4个成串刺激（train-of-four stimulation，TOF）方式监测神经肌肉传递功能，用小样本累积剂量法测定两组患者罗库溴铵量嫩关系的变化。于AHHD前、AHHD完成后即刻记录T1（TOF中的第一个颤搐反应）变化值。用单次剂量法验证累积剂量法测得ED95结果A组T1时血红蛋白（Hb）、红细胞压积（Hct）、血浆总蛋白（TPP）、白蛋白（ALB）均降低（P〈0．05）。C组的罗库溴铵ED50、ED90和ED95分别平均为（178．5±34．7）μg／kg、（209．1±47．8）μg／kg、（304．1±49．5）μg／kg；A组的相应剂量分别为（192．1±24．9）μg／kg、（309．9±142．7）μg／kg、（322．0±44．4）μg／kg。组间比较无统计学差异。累积剂量法与单次剂量法的误差在10％～12％（P〉0．05）.结论6％羟乙基淀粉注射液行AHHD不改变罗库溴铵的量嫩关系。Objective To study the influence of preoperative acute hypervolaemic haemodilution （AHHD） on the dose-response relationship of rocuronium. Methods Forty patients were randomly allocated to AHHD group or control group （n=20）. Anesthesia was maintained with propofol and remifentanyl using TCI, and rocuronium was randomly given with one of six doses（60 μg/kg）. AHHD was conducted with preoperative infusion of 15 ml/kg 6% hydroxyethyl starch at a rate of 30 ml/min. Neuromuscular function was assessed using an accelograph with train-of-four stimulation at wrist. The dose-response relationship of rocuronium was determined with cumulative dose-response technique. Results Hb, Hct, TPP and ALB decreased markedly （P〈0.05） after AHHD. AHHD did not result in a significant shift in rocuronium dose-response curve. There was no significant difference in ED50, ED90, and ED95 between the AHHD group[ （192.1±24.9）μg/kg, （309.9±142.7） μg/kg, （322.0±44.4） μg/kg, respectively] and the control group [ （178.5±34.7）μg/kg, （209.1±47.8）μg/kg, （304.1±49.5）μg/kg, respectively]. Conclusion These results demonstrate that the potency of rocuronium is not affected by AHHD, and roeuronium may become an ideal choice of relaxant in occasion of applying AHHD.

关 键 词：血液稀释 罗库溴铵 量-效关系 

分 类 号：R614[医药卫生—麻醉学]