肥胖患者顺阿曲库铵按去脂肪体重与体重给药的药效学比较  

Pharmacodynamics comparative of cisatracurium in obese patients according to fat-free body weight and real body weight

作　　者：王金辉 高原 王辉 徐申 季中华 Wang Jinhui;Gao Yuan;Wang Hui;Xu Sheny;Ji Zhonghua(Department of Anesthesiology,Zhuhai People's Hospital,Zhuhai 519000,China)

机构地区：[1]广东省珠海市人民医院(暨南大学附属珠海医院)麻醉科,519000

出　　处：《中国医师杂志》2020年第12期1801-1804,1808,共5页Journal of Chinese Physician

基　　金：吴阶平医学基金(wjp-10-18024)。

摘　　要：目的对比研究肥胖患者顺阿曲库铵(CIS)按去脂肪体重(FBW)与实际体重(RBW)给药的药效学差异。方法(1)选择珠海市人民医院2017年6月至2018年6月择期手术全身麻醉患者,采用单次剂量法按FBW计算CIS剂量,80例患者随机数字表法分为:C1组(0.035 mg/kg),C2组.(0.040 mg/kg).C3组(0.050 mg/kg)和C4组(0.060 mg/kg),使用TOF-Watch SX Monitor型加速度肌松监测仪行肌松监测。运用直线回归方法建立CIS量-效关系,计算其FBW的95%的有效剂量(ED95)。(2)另选择本院80例择期手术全身麻醉患者,选取BMI 20~26 kg/m^2为正常体重组,BMI 29~35 kg/m^2为肥胖体重组按以下方法分为四组:按RBW给药正常体重组(NR组)、按FBW给药正常体重组(NF)、按RBW给药肥胖体重组(OR组)和按FBW给药肥胖体重组(OF组),每组20例。比较各组药效学指标的差异。结果CIS按FBW给药的ED95是0.070 mg/kg;与NR组比较,OR组与OF组起效时间缩短,临床持续时间、恢复指数均延长(P<0.05)。与OF组比较,OR组的起效时间缩短,而临床持续时间、药理持续时间和恢复指数均延长,且.插管条件均优,其差异有统计学意义(P<0.01)。OF与OR组药效学指标和离散程度比较,差异均有统计学意义(P<0.05)。结论肥胖患者按RBW计算给药剂量偏大,产生的药效个体差异较大,按FBW给予CIS剂量不仅可达到临床上按RBW给药的相同插管条件及肌松效果满足手术要求而且可减少肌松药剂量,从而减少药效学指标个体之间的差异,提高对肥胖患者围手术期麻醉管理的安全性,对改善肥胖患者预后具有至关重要的临床意义。Objective To compare the pharmacodynamics of cisatracurium(CIS)in obese patients according to fat-free body weight(FBW)and real body weight(RBW).Methods(1)A total of 80 patients undergoing elective general anesthesia in Zhuhai People's Hospital from June 2017 to June 2018 were selected.The CIS dose was calculated by single dose method according to FBW.80 patients were randomly divided into C1 group(0.035 mg/kg),C2 group(0.04 mg/kg),C3 group(0.05 mg/kg)and C4 group(0.06 mg/kg).Muscle relaxation was monitored by TOF watch SX monitor.The dose ffect relationship of CIS was established by linear regression method,and 95%efective dose(ED95)of FBW was calculated.(2)The eighty patients with general anesthesia for elective surgery were selected as normal weight group and obese weight group with BMI of 20-26 kg/m^2 and BMI of 29-35 kg/m^2.The dose of CIS was calculated by 3 times FBW ED95 or 3 times RBW ED95 were divided into four groups:according to RBW normal weight groups(NR),according to FBW normal weight groups(NF),according to RBW obese weight group(OR),according to FBW obese weight group(OF),20 cases in each group.The.pharmacodynamic indexes of each group were compared.Results The ED95 of CIS FBW was 0.07 mg/kg;compared with NR group,the onset time of OR group and OF group was shorter,the clinical duration and recovery index were prolonged(P<0.05)。Compared with OF group,the onset time of OR group was shorter,while the clinical duration,pharmacological duration and recovery index were prolonged(P<0.01),and the intubation conditions were better in OR group(P<0.01).There were signifcant differences in pharmacodynamic indexes and dispersion between OF and OR groups(P<0.05).Conclusions The dose of CIS caleulated by RBW was higher for obese patients,and there are great differences in pharmacodynamics among individuals.Calculaing the dose of CIS according to FBW not only has the intubation condition and muscle relaxation ffeet caleulated according to by RBW,but also can reduce the dosage of muscle relaxation agent.It is

关 键 词：肥胖症 顺式阿曲库铵 药效动力学 药物剂量计算 体重 

分 类 号：R969.1[医药卫生—药理学]