糖尿病患者顺式阿曲库铵肌松效应的探讨  

The neuromuscular effect of cisatracurium in type Ⅱ diabetes mellitus patient

作　　者：阎雁宏[1] 薛纪秀[1] 马艳辉[1] 尹橙[1] 李冰[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》2015年第2期131-133,共3页Beijing Medical Journal

基　　金：北京市科技计划课题(Z121107001012160)

摘　　要：目的在闭环输注系统（CLMRIS-1）指导下比较糖尿病患者与非糖尿病患者顺式阿曲库铵的肌松效应,并探讨糖尿病患者血清中α1-酸性糖蛋白（AAG）水平的变化及其对顺式阿曲库铵药效的影响。方法选择60例拟在全麻下行腹部外科手术的患者,ASAⅠ~Ⅱ级,依据其是否合并2型糖尿病,分为糖尿病组（D组）和非糖尿病组（C组）。麻醉诱导前15 min及术毕即刻,分别抽取静脉血3 ml,离心后取上清1 ml,于-20℃冰箱中保存并及时送检,测定血清中AAG的水平。麻醉诱导采用舒芬太尼、依托咪酯、顺式阿曲库铵。记录两组患者肌松药起效时间T0（注药毕至T1抑制至0的时间）,恢复指数RI（T1从25%恢复至75%的时间）及TOF90（TOF从25%恢复至90%的时间）。结果 2组患者顺式阿曲库铵的起效时间[（4.0±1.1）min vs.（4.1±1.2）min]、恢复指数[（16.8±5.0）min vs.（16.5±3.1）min]及TOF90[（75.0±9.1）min vs.（73.2±6.8）min]差异均无统计学意义（P〉0.05）。同时2组患者术前及术毕即刻血清中AAG水平[（69.1±7.2）mmol/L vs.（68.4±6.7）mmol/L,（69.4±9.8）vs.（68.5±6.2）mmol/L]的差异也无统计学意义（P〉0.05）。结论血糖控制良好的糖尿病患者与非糖尿病患者相比,顺式阿曲库铵的肌松效应并无明显改变,血清中AAG的水平也无明显升高。Objective To compare the neuromuscular effect of cisatracurium in patients with and without type Ⅱdiabetes mellitus by using close loop muscle relaxant injection system （CLMRIS-Ⅰ） and to measure plasma concentration of alpha-1 acid glycoprotein （AAG） to discuss the change of it in diabetes and study its effect on cisatracurium. Methods Sixty patients （ASAⅠ~Ⅱ） scheduled for elective lower or middle abdominal surgery were included. They were divided into two groups （n=30 each）： diabetes group （D） and control group （C）. Serum samples （3 ml） were collected 15 min before in-duction and immediately after the end of the surgery. After centrifugation, serum samples （1 ml） were stored at -20 ℃. Serum samples were drawn right away and the concentration of AAG was measured. The induction was performed with sulfentanyl, etomidate and cisatracurium. The onset time, the recovery index, the time of TOF recovering from 25%to 90%were recorded. Results The onset time [（4.0±1.1）min vs. （4.1±1.2）min], recovery index [（16.8±5.0）min vs. （16.5±3.1）]min and TOF90 [（75.0±9.1）min vs. （73.2±6.8）min] showed no significant difference between the two groups. So did the concen-tration of AAG [（69.1 ±7.2）mmol/L vs. （68.4 ±6.7）mmol/L] and [（69.4 ±9.8）mmol/L vs. （68.5 ±6.2）mmol/L, （P〉0.05）]. Con-clusion Compared with patients without diabetes, diabetes with well controlled blood glucose does not show significant difference in both neuromuscular effects of cisatracurium and the concentration of AAG.

关 键 词：闭环输注系统 糖尿病 顺式阿曲库铵 肌松效应 Α1-酸性糖蛋白 

分 类 号：R614[医药卫生—麻醉学]