基于改良衰弱指数评估老年患者衰弱程度对顺式阿曲库铵作用的影响  

Impact of evaluating frailty in elderly patients using improved frailty index on action of cisatracurium

作　　者：薛松[1] 汪平娟 江涛[1] 刘玉[1] 李查兵 王义桥 Xue Song;Wang Pingjuan;Jiang Tao;Liu Yu;Li Chabing;Wang Yiqiao(Anhui No.2 Provinicial People's Hospital Clinical College of Anhui Medical University,Anhui No.2 Provinicial People's Hospital,The Fifth Clinical Medical College of Anhui Medical University,Hefei,Anhui,230041,China)

机构地区：[1]安徽医科大学安徽省第二人民医院临床学院,安徽省第二人民医院,安徽医科大学第五临床医学院,安徽合肥230041

出　　处：《齐齐哈尔医学院学报》2025年第1期35-39,共5页Journal of Qiqihar Medical University

基　　金：安徽省高等学校科学研究重点项目(自然科学类)(2023AH053373)。

摘　　要：目的探讨老年患者的衰弱状态对顺式阿曲库铵的起效时间和作用时间的影响。方法选择2022年6月—2024年4月本院收治的择期行腹腔镜下胃癌根治手术的老年患者(年龄大于65岁)作为研究对象,术前访视时根据改良衰弱指数(modified Frailty Index mFI-11)评估量表对老年患者进行改良衰弱指数评估并记录。随机选取没有数据缺失项的患者87例纳入本研究中,采集数据后根据mFI-11指数分为两组:mFI<0.27分为C组(非衰弱组),mFI≥0.27分为D组(衰弱组)。两组患者均行气管插管全麻(麻醉诱导、维持方案一致),入室后均进行肌松监测,分别记录患者入室镇静镇痛药物推注之后加速度肌松监测仪测得的T1及TOfr基础值(TOFrc),顺式阿曲库胺(0.15 mg/kg)推注后TOFr为0的时间(t0)、术中第1次TOFr为0.25的时间(t1)等数据,并进行比较分析。结果两组患者在罹患高血压、糖尿病、周围血管疾病、感觉障碍、生活依赖程度、短暂性脑缺血发作或脑血管意外病史以及脑血管事件伴神经功能受损方面比较,差异均具有统计学意义(P<0.05);两组间t0时间比较,D组较C组t0时间明显缩短,差异具有统计学意义(P<0.01);两组间t1时间比较,D组较C组t1时间明显延长,差异具有统计学意义(P<0.01);两组间T1及TOFrc没有统计学意义(P>0.05)。结论改良衰弱指数评估为衰弱状态的患者与非衰弱状态患者相比,肌松监测下显示顺式阿曲库胺推注后,达到TOFr=0的时间更短、术中恢复到TOFr=0.25的时间更长,即随着衰弱程度的增加,顺式阿曲库胺起效时间更短,肌松开始恢复的时间则需要更长。Objective To investigate the impact of frailty status in elderly patients,as assessed by the modified Frailty Index(mFI-11),on the onset and duration of action of cisatracurium.Methods Elderly patients(over 65 years old)scheduled for laparoscopic radical gastrectomy at our hospital from June 2022 to April 2024 were selected as the study subjects.The modified Frailty Index(mFI-11)was used to assess frailty during preoperative visits and records were maintained.A total of 87 patients with complete data were randomly selected for this study.Post-data collection,patients were divided into two groups based on the mFI-11 index:Group C(non-frail group)with mFI-11<0.27,and Group D(frail group)with mFI-11≥0.27.Both groups underwent general anesthesia with endotracheal intubation following the same induction and maintenance protocol.Muscle relaxation monitoring was performed upon room entry,and data included T1 and TOfr baseline values(TOFrc)measured by acceleromyography after sedative and analgesic administration.The time(t0)for TOFr to reach 0 after cisatracurium(0.15 mg/kg)administration and the time(t1)for TOFr to first achieve 0.25 during surgery were recorded and analyzed.Results Statistically significant differences were observed between the two groups in terms of hypertension,diabetes,peripheral vascular diseases,sensory disorders,degree of life dependence,history of transient ischemic attack or cerebrovascular accident,and neurological impairment due to cerebrovascular events(P<0.05).Group D had a significantly shorter t0 time compared to Group C(P<0.01),and a significantly longer t1 time(P<0.01).No significant differences were found in T1 and TOFrc between the groups(P>0.05).Conclusions Patients assessed as frail by the mFI-11 showed a shorter time to reach TOFr=0 and a longer time to recover to TOFr=0.25 after cisatracurium administration,indicating that increased frailty is associated with a shorter onset time and a longer recovery time for muscle relaxation.

关 键 词：改良衰弱指数 mFI-11 四个成串刺激 老年 顺式阿曲库胺 

分 类 号：R614[医药卫生—麻醉学]