年龄对重症肌无力患者顺式阿曲库铵肌松效应的影响  

Influence of age on neuromuscular block effect of cisatracurium in myasthenia gravis patients

作　　者：贾瑞芳[1] 周淑珍[1] 张宏业[1] 左明章[1] 

机构地区：[1]北京医院麻醉科,100730

出　　处：《中华老年医学杂志》2015年第10期1099-1102,共4页Chinese Journal of Geriatrics

基　　金：中华医学会临床医学科研专项资金资助项目（13081420527）

摘　　要：目的观察重症肌无力（MG）患者术中应用顺式阿曲库铵的肌松效应，比较老年MG患者与中青年MG患者顺式阿曲库铵肌松效应的差别。方法择期胸腔镜下行胸腺切除术的MG患者，根据年龄分为老年组（≥65岁）和中青年组（20～50岁）。其中老年组IIb型MG有15例，从中青年组中根据性别、病情、病程、术前治疗情况、麻醉用药、手术时间配对选择IIb型MG患者15例。麻醉诱导期用TOFWatchSX肌松监测仪行拇内收肌肌松监测，静注顺式阿曲库铵，首剂量从0．05mg／kg[1倍95％有效剂量（ED95）]开始，根据TOF值追加顺式阿曲库铵0．015mg／kg，直到T1／T0〈95％时实施双腔气管支气管导管插管。术中当T4／T1达到25％时追加0．015mg／kg顺式阿曲库铵。观察顺式阿曲库铵的插管剂量和作用时间、临床作用持续时间、术毕TOFr（T4／T1）恢复到25％、70％和90％的时间。结果老年MG组和中青年MG组顺式阿曲库铵的插管剂量和首剂量的作用持续时间差异无统计学意义（均P〉0．05）；术中老年MG组顺式阿曲库铵的临床作用时间（21．6±6．7）min，较中青年MG组顺式阿曲库铵的临床作用时间（33．7±13．4）min短（t=-2．139，P=0．045）；老年MG组术中追加顺式阿曲库铵（3．9±1．3）次，多于中青年MG组术中追加次数（2．3士2．2）次（t=2．601，P=0．025）；术毕中老年组TOFr恢复到25％的时间（22．1士6．9）min短于中青年MG组TOFr恢复到25％的时间（34．0±18．3）min（t=2．139，P=0．037）；两组患者术毕TOFr恢复到70％和90％的时间差异无统计学意义（均P〉0．05）。结论老年MG患者的顺式阿曲库铵阻滞时间较中青年MG患者有不同程度的缩短；有必要进行更多的相关研究来进一步明确年龄对MG患者顺式阿曲库铵以及其他肌松药肌松效应的影响。Objective To investigate the neuromuscular block effect of intravenous injection of cisatracurium in myasthenia gravis patients with different ages. Methods Fifteen geriatric patients defined as geriatric group（≥ 65 years old）with ASA I- Ⅱ scheduled for video-assisted thoracoscopie （VATS）thymectomy with Ⅱ b MG and fifteen young-midctle aged Ⅱb MG patients defined as youngmiddle aged group （20-50 years） with paired sex, clinical symptoms, duration of symptoms, preoperative treatment regimen, anesthesia management and surgical time were included. Neuromuscular block was monitored with TOF Watch acceleration instrument. After induction of intravenous anesthesia, 0.05mg/kg Cisatracurium was administrated intravenously, followed by increments of 0. 015 mg/kg until T1/T0 was less than 5% for each patient. A double-lumen bronchial tube was intubated when T1/T0 was less than5M. 0. 015 mg/kg cisatracurium was injected during the operation when T4/T1 was achieved to 25%. The dose of cisatracurium, the duration of blockade maintenance,duration of clinical action and neuromuscular block recovery index were obtained. Results There were no significant differences in tracheal doses of cisatracurium [（0. 058± 0. 013） mg/kg w （0.053±0.009）mg/kg]and the duration of blockade [（31.5±9.6）min vs. （40.0±19.8） mini between geriatric group and young-middle age group （P〉0.05）. The duration of clinical action of cisatracurium [（21.6±6.7）rain vs. （33.7±13.4）min]and the time to achieve a TOFr of 25% were significantly shorter in geriatric MG group than those in young-middle：aged MG group （P= 01 045 , 0. 037）. The geriatric MG group were administrated more increments of ciastracurium than the youngmiddle aged MG group during surgery （P=0. 025）. There was no significant difference in the time to achieve a TOFr of 70%（49.3±16. 4）min vx （57.4±34.7）mini and 90% [（61. 6±19. 2）min vs. （64.3±35.9）min] between geriatric MG group and young-middle aged MG group（P〉

关 键 词：重症肌无力 阿曲库铵 肌松弛 

分 类 号：R614[医药卫生—麻醉学]