顺式阿曲库铵的血药浓度与TOF的相关性分析  

The relation between plasma concentration of cisatracurium and the reversal of train of four

作　　者：阎雁宏[1] 薛纪秀[1] 马艳辉[1] 尹橙[1] 李冰[1] 沈芊[1] 

机构地区：[1]首都医科大学宣武医院麻醉科,北京100053

出　　处：《北京医学》2014年第8期632-634,共3页Beijing Medical Journal

基　　金：北京市科技计划课题(Z121107001012160)

摘　　要：目的 通过测定顺式阿曲库铵的血药浓度及肌松监测,探讨用血药浓度代表肌松恢复程度的可行性,以期为顺式阿曲库铵的靶控输注提供参考。方法 选择30例,ASAⅠ~Ⅱ级拟在全麻下行择期手术的患者。麻醉诱导采用依托咪酯,舒芬太尼,顺式阿曲库铵（0.2 mg/kg）;麻醉维持采用丙泊酚,瑞芬太尼持续输注。分别记录肌松药的起效时间T0（注药毕至T1抑制至0的时间）,从4个成串刺激（train of four,TOF）开始恢复至恢复50%、75%、90%及100%的时间TOFr50、TOFr75、TOFr90、TOFr100,并分别于上述时间点采集输液对侧动脉血3 ml,以测定相应时间点顺式阿曲库铵的血药浓度。结果 顺式阿曲库铵的起效时间T0为（3.35±1.03）min,TOFr50为（21.03±7.91）min,其血药浓度占初始血药浓度的百分比R50为（32.15±11.53）%;TOFr75为（30.36±10.70）min,R75为（18.87±7.53）%;TOFr90为（38.80±11.00）min,R90为（14.85±8.70）%;TOFr100为（46.67±13.34）min,R100为（8.30±3.45）%。经Pearson相关性检验,变量TOFr与R呈显著负相关（r=-0.688）。结论 血浆药物浓度的衰减与肌松程度的恢复之间具有明显的相关性,用血药浓度代表肌松恢复程度具有一定可行性。Objective To discuss the feasibility of using plasma cisatracurium concentration as a surrogate marker for the reversal of train of four（TOF） and provide reference for the TCI of cisatracurium. Methods Thirty patients （ASAⅠ-Ⅱ） scheduled for selective surgery under general anesthesia were included in the study. Anesthesia was induced with e-tomidate, sulfentanyl and cisatracurium （0.2 mg/kg）. During the surgery, propofol and remifentanyl were continuously in-fused. The following parameters were recorded：the onset time （T0）, TOFr50, TOFr75, TOFr90, and TOFr100. At each time point, 3 ml of atrial blood were withdrawn from the contralateral arm to detect the plasma concentration of cisatracurium. Results The onset time （T0） was （3.35±1.03） min; TOFr50 was （21.03±7.91） min and the percentage of cisatracurium at this time （R50） was （32.15±11.53）%;TOFr75 was （30.36±10.70） min and R75 was （18.87±7.53）%;TOFr90 was （38.80± 11.00） min and R90 was （14.85±8.70 ）%;TOFr100 was （46.67±13.34） min and R100 was （8.30±3.45）%. The result of Pearson correlation analysis indicated a significant increase in TOFr with the decrease of R（r=-0.688）. Conclusion It is feasible to use plasma concentration of cisatracurium as the surrogate marker for the reversal of TOF.

关 键 词：顺式阿曲库铵 血药浓度 4个成串刺激 

分 类 号：R614[医药卫生—麻醉学]