眼肌型和全身型重症肌无力患者罗库溴铵肌松时效的比较  

Difference in time-course of relaxant effect of rocuronium between patients with ocular and generalized myasthenia gravis

作　　者：曹迎亚[1] 鲁卫华[1] 姜小敢[1] 金孝岠[1] 鲁美静[1] 

机构地区：[1]皖南医学院弋矶山医院麻醉与重症医学科,安徽省芜湖市241001

出　　处：《中华麻醉学杂志》2013年第6期683-686,共4页Chinese Journal of Anesthesiology

基　　金：安徽省卫生厅医学科研项目（2010C066）

摘　　要：目的比较眼肌型和全身型重症肌无力患者罗库溴铵的肌松时效。方法择期行胸骨正中切口胸腺切除术的27例患者，性别不限，年龄12～64岁，体重指数17～26kg／rn2，ASA分级I或Ⅱ级，根据Osserman分型分为2组：眼肌型组（0组，n=10）和全身型组（G组，n=17）。依次静脉注射芬太尼2gg／kg、咪达唑仑0．05mg／kg和丙泊酚1．5mg／kg行麻醉诱导，气管插管，采用四个成串刺激模式，刺激电流60mA，间隔12s，频率2Hz，波宽0．2ms，监测拇内收肌肌颤搐，定标后静脉注射罗库溴铵0．6mg／kg。记录麻醉诱导前（基础状态）、气管插管后1、3min时MAP、HR、心率变异性和低频与高频比值，记录肌松起效时间、T1、25％恢复时间、T1 50％恢复时间和恢复指数。结果与基础值比较，2组不同时点MAP、HR、心率变异性和低频与高频比值差异无统计学意义（P〉0．05）；与0组比较，G组肌松起效时间差异无统计学意义（P〉0．05），L25％恢复时间、T1 50％恢复时间及恢复指数延长（P〈0．05）。结论罗库溴铵在全身型MG患者的肌松维持时间长于眼肌型，而起效时间无差异。Objective To compare the time-course of relaxant effect of rocuronium between patients with ocular and generalized myasthenia gravis （ MG）. Methods Twenty-seven ASA physical status I or 11 patients with MG of both sexes, aged 12-64 yr, with body mass index of 17-26 kg/m2, scheduled for elective extended thymectomy, were divided into 2 groups according to Osserman stage： ocular group （group 0, n = 10） and generalized group （group G, n = 17）. Anesthesia was induced with iv injection of fentanyl 2 ug/kg, midazolam 0.05 mg/kg, and propofol 1.5 mg/kg. All patients were tracheal intubated and mechanically ventilated. Anesthesia was maintained with iv infusion of propofol 4-8 mg·kg- 1 . h- 1 and remifentanil 0.2ug·kg- 1·min- 1 . Twitch tension was monitored in the adductor pollicis muscle by train-of-four stimulation of the ulnar nerve （intensity 60 mA, in- terval 12 s, frequency 2 Hz, wave length 0.2 ms） . Rocuronium 0.6 mg/kg was injected intravenously after cali- bration. Mean arterial pressure （MAP）, HR, heart rate variability （HRV） and low frequency and high frequency （LF/HF） ratio was recorded. The onset time of muscle relaxation, time for T1 to recover to 25%, time for T1 to recover to 50 % and recovery index were recorded. Results Compared with the baseline value, there were no sig- nificant changes in MAP, HR, HRV, LF/HF ratio at all time points in the two groups （P 〉 0.05） . Compared with group O, there was no significant change in the onset time of muscle relaxation, and the time for T1 to recover to 25 % , time for T1 to recover to 50 % and recovery index were significantly prolonged in group G （ P 〈 0.05 ）. Conclusion The duration of rocuronium-induced neuromuscular block is significantly longer in patients with generalized MG than those with ocular MG, while the onset time is comparable between the two groups.

关 键 词：雄甾烷醇类 重症肌无力 神经肌肉阻滞 

分 类 号：R746.1[医药卫生—神经病学与精神病学]