不同效应室靶浓度异丙酚对喉显微手术患者围麻醉期米库氯铵药效学及药动学的影响  

Effect of different target concentration of Propofol on pharmacodynamics and pharmacokinetics of Mivacurium Chloride during perianesthesia of patients underwent microlaryngoscopic surgery

作　　者：徐迎阳 高光洁 龙晓宏 尚宇 

机构地区：[1]解放军第四六三医院麻醉科,辽宁沈阳110042

出　　处：《中国医药导报》2017年第19期65-68,共4页China Medical Herald

基　　金：辽宁省自然科学基金项目(2015020416)

摘　　要：目的比较不同靶浓度异丙酚对喉显微手术患者围麻醉期米库氯铵药效学及药动学的影响。方法选择2015年6月~2016年9月解放军第四六三医院ASAⅠ~Ⅱ级择期行喉显微手术患者60例,采用随机数字表法将患者分为Ⅰ、Ⅱ、Ⅲ组,每组各20例,异丙酚效应室靶浓度分别为3.0、4.0、5.0μg/m L。靶控输注异丙酚60 s后,分别静脉注射芬太尼10μg/kg、米库氯铵0.2 mg/kg,快速气管内插管,复合盐酸瑞芬太尼0.25μg/(kg·min)维持麻醉镇痛。采用肌松监测仪连续监测尺神经4个成串刺激反应(TOF),记录肌松时效指标。全程监测血流动力学和脑电双频谱指数(BIS)变化,同时测定米库氯铵药代动力学情况。结果血流动力学参数比较,三组差异无统计学意义(P>0.05)。三组患者米库氯铵起效时间差异无统计学意义(P>0.05),4个成串刺激(TOF)T1值恢复25%时间、T1值恢复75%时间、T1值恢复90%时间、TOF比值(T4/T1)恢复70%时间,Ⅲ组明显延长,与Ⅰ组比较,差异有统计学意义(P<0.05)。米库氯铵药代动力学参数变化,除相对生物利用度(F)外,其余指标,Ⅲ组与Ⅰ、Ⅱ组比较,差异均有高度统计学意义(P<0.01)。结论异丙酚效应室靶浓度变化与米库氯铵药代动力学改变有剂量依赖相关性,异丙酚效应室靶浓度为4.0μg/m L时,对米库氯铵药效学影响较小。Objective To compare the effect of of different target concentration of Propofol on pharmacodynamics and pharmacokinetics of Mivacurium Chloride during perianesthesia of patients underwent microlaryngoscopic surgery. Methods 60 cases of patients with ASA Ⅰ -Ⅱ underwent selective microlaryngoscopic surgery from June 2015 to September 2016 in 463th Hospital of PLA were selected, and divided into group Ⅰ , Ⅱ, Ⅲ by random number table, each gorup had 20 eases. The target effect-sit concentration of Propofol was 3.0, 4.0, 5.0μg/mL respectively. After target controlled infusion of Propofol for 60 s, intravenous injection of Fentanyl 10 μg/kg, Mivacurium Chloride 0.2 mg/kg was given, and endotracheal intubation rapidly. Anesthesia was maintained with Remifentanil Hydrochloride 0.25μg/（kg ·min）. Ulnar nerve train of 4 stimulation （TOF） was monitored continuously by using acceleration muscle relaxation monitor. Muscle relaxant indicators were recorded. Hemodynamics and BIS were monitored during the whole anesthesia. The pharmacokinetic effects of Mivacurium were measured. Results Comparison of the hemodynamic parameters in the three groups had no significant differences （P〉 0.05）. The onset time of Mivacurium in the three groups had no statistically significant difference （P〉 0.05）. 25%, 75%,90%T1 recovery time of TOF and 70% T4/T1 recovery time in the group III were significantly prolonged than those of the group I , with statistically significant differences （P 〈 0.05）. In the pharmacokinetic of Mivacurium, in addition to relative bioavailability （F）, the rest of the indicators, compared with the groupⅠ, Ⅱ and group Ⅲ, the differences were statistically significant （P 〈 0.01）. Conclusion The target effect-sit Propofol concentration and pharmaeokinetics of Mivacurium has a dose-dependent correlation. Mivacurium pharmacodyn-amics is unsignificantly effected by target effect-sit propofol concentration of 4.0μg/mL.

关 键 词：靶控输注 异丙酚 米库氯铵 药代动力学 喉显微手术 

分 类 号：R614.2[医药卫生—麻醉学]