血清乙酰胆碱受体抗体阳性和阴性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 in acetylcholine receptors antibody seropositive and seronegative patients with myasthenia gravis

作　　者：曹迎亚[1] 鲁卫华[1] 姜小敢[1] 鲁美静[1] 吴敬医[1] 秦雪梅[1] 姚卫东[1] 

机构地区：[1]皖南医学院弋矶山医院麻醉与重症医学科

出　　处：《中国临床药理学与治疗学》2014年第10期1153-1157,共5页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：安徽省卫生厅医学科研项目(2010C066)

摘　　要：目的:探讨罗库溴铵在血清乙酰胆碱受体(AchR)抗体阳性和阴性重症肌无力(MG)患者中的肌松效应。方法:选择择期行胸骨正中切口胸腺切除术的20例MG患者,根据术前血液生化检查分为AchR抗体阳性组(P组,n=10)和AchR抗体阴性组(N组,n=10)。依次静脉注射芬太尼2μg/kg,咪唑安定0.05mg/kg,丙泊酚1.5mg/kg行麻醉诱导,气管插管,采用四个成串刺激监测拇内收肌肌颤搐,刺激电流60mA,间隔12s,频率2Hz,波宽0.2ms,定标后静脉注射罗库溴铵0.6mg/kg。分别记录肌松起效时间、T125%恢复时间、T150%恢复时间和恢复指数。术中使用多功能监测仪进行心率变异性分析。结果:两组患者各时点MAP、HR、HRV、LF/HF差异无统计学意义(P>0.05)。与N组比较,P组肌松起效时间的差异无统计学意义(P>0.05),P组T125%恢复时间、T150%恢复时间及恢复指数延长(P<0.05)。结论:罗库溴铵在血清AchR抗体阳性MG患者的维持时间长于血清阴性患者,而起效时间无差异。AIM：To compare the time-course of relaxant effect of rocuronium in Acetylcholine receptors（AchR）antibody seropositive and seronegative patients with myasthenia gravis（MG）.METHODS：Twenty ASAⅠorⅡMG patients with both sexes,aged 23-59 years,with body mass index of 18-25kg/m2 ,scheduled for elective extended thymectomy,were divided into2 groups according to AChR antibody test：seropositive group（group P,n=10）and seronegative group（group N,n=10）.Aesthesia was induced with iv injection of fentanyl 2μg/kg,midazolam 0.05 mg/kg,and propofol 1.5 mg/kg. All patients were tracheal intubated and mechanically ventilated.Twitch tension was monitored in the adductor pollicis muscle by train-of-four stimulation of the ulnar nerve（intensity 60 mA,interval 12s,frequency 2 Hz,wave length 0.2ms）.Rocuronium 0.6mg/kg was injected intravenously after calibration.The onset time of muscle relaxation,and time for T1 to recover to25%,time for T1 to recover to 50%a nd recovery index were recorded.The heart rate variability（HRV）was analyzed during the surgery.RESULTS：There were no significant changes in MAP, HR, HRV,LF/HF ratio at all time in two groups（P〉0.05）.Compared with group N,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 P（P〈0.05）.CONCLUSION：The duration of rocuronium-induced neuromuscular block is significantly longer in seropositive patients with MG than seronegative,while the onset time is similar between the two groups.

关 键 词：雄甾烷醇类 重症肌无力 乙酰胆碱受体抗体 神经肌肉阻滞 心率变异性 

分 类 号：R746.1[医药卫生—神经病学与精神病学]