糖化血红蛋白水平对全麻患者顺阿曲库铵肌松效应的影响  

Effect of glycosylated hemoglobin level on cisatracurium-induced muscle relaxation in patients undergoing general anesthesia

作　　者：冯磊[1] 于宝臣 瞿秋[1] 王海云[1] Feng Lei;Yu Baochen;Qu Qiu;Wang Haiyun(The Third Central Hospital of Tianjin Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases Tianjin Artificial Cell Engineering Technology Research Center Tianjin Institute of Hepatobiliary Disease,Tianjin 300170,China)

机构地区：[1]天津市第三中心医院,天津市重症疾病体外生命支持重点实验室,天津市人工细胞工程技术研究中心,天津市肝胆疾病研究所,300170

出　　处：《中华麻醉学杂志》2020年第11期1375-1377,共3页Chinese Journal of Anesthesiology

摘　　要：目的探讨糖化血红蛋白(HbA1c)水平对全麻患者顺阿曲库铵肌松效应的影响。方法择期全麻下行鼻窦开窗术患者160例,性别不限,年龄30~60岁,体重指数20~25 kg/m2,ASA分级Ⅰ或Ⅱ级。根据术前1 d HbA1c水平分为4组(n=40),对照组(C组):HbA1c≤6%;不同水平HbA1c组:6%9%(D3组)。D1组、D2组和D3组患者糖尿病病程≥5年,术前空腹血糖6.1~10.0 mmol/L。静脉注射咪达唑仑、芬太尼和异丙酚麻醉诱导后行肌松监测,T1稳定在100%时,静脉注射顺阿曲库铵0.15 mg/kg,肌松起效后行气管内插管术。静脉输注丙泊酚、瑞芬太尼和右美托咪定麻醉维持。记录顺阿曲库铵起效时间、临床作用时间、恢复时间、恢复指数和90%恢复指数。结果与C组和D1组比较,D2和D3组顺阿曲库铵起效时间、临床作用时间、恢复时间、恢复指数及90%恢复指数延长(P<0.05);C组和D1组顺阿曲库铵肌松效应各指标比较差异无统计学意义(P>0.05);与D2组比较,D3组顺阿曲库铵起效时间、临床作用时间、恢复时间、恢复指数及90%恢复时间延长(P<0.05)。结论 HbA1c>7%可延长全麻患者顺阿曲库铵起效时间和作用时间,抑制其肌松恢复;且HbA1c水平越高,对顺阿曲库铵肌松效应的影响越大。Objective To investigate the effect of glycosylated hemoglobin(HbA1c)level on cisatracurium-induced muscle relaxation in the patients undergoing general anesthesia.Methods One hundred and sixty patients of both sexes,aged 30-60 yr,with body mass index of 20-25 kg/m2,of American Society of Anesthesiologists physical statusⅠorⅡ,scheduled for elective endoscopic sinus surgery with general anesthesia,were included in the study.According to the HbA1c level at 1 day before operation,the patients were divided into 4 groups(n=40 each):HbA1c≤6%control group(group C),6%<HbA1c≤7%group(group D1),7%<HbA1c≤9%group(group D2),and HbA1c>9%group(group D3).The duration of diabetes mellitus was≥5 yr,and the preoperative fasting blood glucose was 6.1-10.0 mmol/L in D1,D2 and D3 groups.After anesthesia was induced with intravenous midazolam,fentanyl and propofol,muscle relaxation was monitored.When T1 was maintained at 100%,cisatracurium 0.15 mg/kg was intravenously injected,and endotracheal intubation was performed after onset of the muscle relaxant.Anesthesia was maintained with infusion of propofol,remifentanil and dexmedetomidine.The onset time,clinical action time,recovery time,recovery index and 90%recovery index were recorded.Results Compared with group C and group D1,the onset time,clinical action time,recovery time,recovery index and 90%recovery index were significantly prolonged in D2 and D3 groups(P<0.05).There was no significant difference in each parameter between group C and group D1(P>0.05).Compared with group D2,the onset time,clinical action time,recovery time,recovery index and 90%recovery index were significantly prolonged in group D3(P<0.05).Conclusion HbA1c>7%can prolong onset time and time for action of cisatracurium and inhibit the recovery of muscle relaxation in patients undergoing general anesthesia,and the higher the level of HbA1c,the greater the effect on the cisatracurium-induced muscle relaxation.

关 键 词：血红蛋白A 糖基化 阿曲库铵 神经肌肉阻滞 

分 类 号：R614.2[医药卫生—麻醉学]