维库溴铵应用于梗阻性黄疸患者中的肌松时效研究  

Neuromuscular Blocking Effect of Vecuronium in Patients with Obstructive Jaundice

作　　者：刘德昭[1] 甘小亮[1] 李晓芸[1] 罗晨芳[1] 黑子清[1] 

机构地区：[1]广东省广州市中山大学附属第三医院麻醉科,510630

出　　处：《中华全科医学》2012年第8期1187-1189,共3页Chinese Journal of General Practice

基　　金：广东省医学科研基金(A2009197);广东省科技计划项目(2011B031800058)

摘　　要：目的探讨维库溴铵在梗阻性黄疸患者中应用的肌松时效。方法选择择期腹部手术患者100例,分为两组:实验组(E组,n=50)为梗阻性黄疸患者,ASAⅡ～Ⅲ级;对照组(C组,n=50)为血胆红素正常的患者,ASAⅠ～Ⅱ级。两组均采用丙泊酚复合瑞芬太尼全凭静脉麻醉,并应用TOF-Guard肌松监测仪监测神经肌肉阻滞情况。维库溴铵首量为0.15 mg/kg(3倍ED95剂量)。当术中T4/T1恢复到25%时追加维库溴铵1×ED95(0.05 mg/kg)。记录麻醉诱导时肌松起效时间、无反应时间、恢复指数、平均体内作用时间和拔管时间。结果①与C组比较,E组的血清总胆红素、直接胆红素、谷丙转氨酶(ALT)、谷草转氨酶(AST)明显增高(P<0.05),而白蛋白(ALB)、白蛋白/球蛋白比值(A/G比值)则明显降低(P<0.05);②E组的肌松起效时间、无反应时间、恢复指数、平均体内作用时间、拔管时间比C组明显延长(P<0.05)。结论梗阻性黄疸可导致维库溴铵药效时间和恢复时间延长,临床应用时应加强肌松监测,避免肌松残留。Objective To explore the Time-course effect on muscle relaxation of Vecuronium in patients with obstructive jaundice.Methods By the random,double blind,parallel controlled method,100 patients scheduled for upper abdominal surgery were divided into two groups：Experiment group（E group） and Control group（C group）.E group included 50 ASA Ⅱ-Ⅲ patients with obstructive jaundice and C group included 50 ASA Ⅰ-Ⅱ with normal liver function.All patients received a total intravenous anaesthesia with propofol and remifentanil.The 3×ED95（0.15 mg/kg） of Vecuronium was given during anaesthesia induction.Neuromuscular blockade was assessed with TOF-Guard muscle relax monitor during operation.When the value of T4/T1 reached to 25%,1×ED95（0.05 mg/kg） of Vecuronium was added.The onset time,no-reaction duration,recovery index,mean duration of action and extubation time was recorded.Results ①Compared with C Group,the TBIL,DBIL,ALT,AST of E group increased significantly（P0.05）,and the ALB,A/G ratio were decreased significantly（P0.05）;②The onset time,recovery index,mean duration of action and extubation time in E group were all slower than in C group（P0.05）;There were no significant no-reaction duration between the two groups.Conclusion The obstructive jaundice can prolong the clinical duration of Vecuronium action and recovery time,and muscle relax monitor should be strengthened to avoid muscle relaxant residues.

关 键 词：梗阻性黄疸 维库溴铵 神经肌肉阻滞 肌松时效 

分 类 号：R575[医药卫生—消化系统]