不同体重指数对顺苯磺酸阿曲库铵药效学的影响  

Effect of body mass index on neuromuscular blockage induced by cisatracurium

作　　者：陈汉文[1] 邢祖民[1] 刘中杰[2] 磨凯[2] 刘辉[2] 徐世元[2] 

机构地区：[1]顺德第一人民医院麻醉科,广东佛山528300 [2]南方医科大学珠江医院麻醉科,广东广州510282

出　　处：《热带医学杂志》2014年第5期686-688,共3页Journal of Tropical Medicine

摘　　要：目的探讨不同体重指数对顺苯磺酸阿曲库铵药效学的影响。方法全身麻醉择期手术患者40例，ASAⅠ～Ⅲ级，按体重指数的不同分为四组：偏瘦组（Ⅰ组），BMI〈18．5kg／m^2；正常体重组（Ⅱ组），BMI 18．6—24．9kg／m^2；超重组（Ⅲ组），BMI25．0～30．0kg／m^2；肥胖组（Ⅳ组），BMI≥30．0kg／m^2。四组均按实际体重分别给予0．15mg／kg（3ED95）顺苯磺酸阿曲库铵。使用加速度肌松监测仪（TOF-Watch SX）行TOF监测拇内收肌肉阻滞（NMB）程度。麻醉采用全凭静脉麻醉诱导及维持。当T1达最大抑制值（T1降至最低值并重复3次以上不变时）时进行气管插管。记录起效时间（从肌松药注毕至T1达到最大抑制值的时间）、临床作用时间（注药结束到T1恢复至25％的时间）、药理作用时间（注药结束到T1恢复至90％的时间）、恢复指数（T1从25％恢复到75％的时间）和气管插管条件评级。结果体重指数与3倍ED95顺苯磺酸阿曲库铵的临床作用时间呈线性相关，回归方程为Y=1．531X＋8．479（R2=0．628，P〈0．01）；BMI与3倍ED95顺苯磺酸阿曲库铵药理作用时间呈线性相关，回归方程为Y=1．954X＋15．049（R2=0．585，P〈0．01）。4组患者的临床作用时间和药理作用时间差异有统计学意义（P〈0．05），而起效时间、恢复指数和插管条件差异均无统计学意义（P〉0．05）。结论顺苯磺酸阿曲库铵按实际体重3倍ED95给药，随着患者的体重指数增高，其临床作用时间和药理作用时间亦随之延长，体重指数是影响该药恢复时间的重要因素之一。Objective To observe the effect of body mass index on neuromuscular blockage induced by cisatracurium. Methods Forty ASA Ⅰ - Ⅲ patients undergoing elective surgery under total intravenous anesthesia were enrolled in this study. All patients were divided into 4 groups： group I （slim） with BMI 〈 18.5 kg/m2; group Ⅱ （normal） with BMI 18.6- 24.9 kg/m2; group Ill （overweight） with BMI 25.0-30.0 kg/m2; group Ⅳ （obesity） with BMI ≥30.0 kg/m2. Four groups received cisatracurium 0.15 mg/kg according to real body weight. The responses of adductor pollicis to train of four （TOF） stimulation of ulnar nerve were monitored by TOF-Watch SX muhifunction monitor. General anaesthesia was induced and maintained with target-controlled infusion. Intubation was attempted when T1 reached maximal inhibition （T2 minimize repeated more than 3 times）. The onset time （time from end of bolus injection to 100% twitch depression）, intubation conditions, clinical duration （time from the end of bolus injection to recovery of twitch tension to 25% of control）, pharmacological duration （time from the end of bolus injection to recovery of twitch tension to 90% of control） and recovery index （the time lapse from 25% to 75% of recovery of T1） were recorded. Results A significant correlation between clinical duration and BMI （RZ=0.628 ,P〈0.01 ） was found by linear regression analysis. A significant correlation was also found between pharmacological duration and BMI（R2=0.585,P〈0.01）. Conclusion In adult patients, the clinical duration and pharmacological duration of cisatracurium increases with BMI when the drug is administered according to actual body weight.

关 键 词：体重指数 顺苯磺酸阿曲库铵 ED95 

分 类 号：R971[医药卫生—药品]