Selection of neuromuscular blocking agents in patients undergoing renal transplantation under general anesthesia  

全麻肾移植术的肌松药选择(英文)

作　　者：马皓琳[1] 庄心良[1] 

机构地区：[1]上海市第一人民医院麻醉科,上海200080

出　　处：《Chinese Medical Journal》2002年第11期1692-1696,154,共5页中华医学杂志（英文版）

摘　　要：OBJECTIVE: To study the pharmacodynamics of vecuronium,atracurium, mivacurium and rocuronium in patients with end-stage renal failure. METHODS: Forty-six patients with end-stage renal failure scheduled for renal transplantation and 53 patients with normal renal function were given either vecuronium, atracurium, mivacurium or rocuronium. The neuromuscular effects were monitored by the evoked response of the adductor pollicis to train-of-four stimulation of the ulnar nerve. RESULTS: Onset of vecuronium, atracurium and mivacurium occurred faster or tended to be faster in patients with end-stage renal failure, but there was no significant difference in onset by rocuronium between the control patients and renal failure patients. Furthermore, the no-response period, duration of action and recovery of atracurium did not differ between the two groups. There was no significant difference in duration of action or recovery of mivacurium between the two groups, whereas its no-response period was significantly prolonged in the patients with end-stage renal failure. There was no difference in no-response period or duration of action after the initial dose of vecuronium or rocuronium between the two groups. However, no-response period and duration of effect by vecuronium and rocuronium were prolonged with increasing incremental doses in patients with end-stage renal failure. CONCLUSIONS: All four muscle relaxants could be safely used in patients with end-stage renal failure. Onset of the relaxants were, in some cases, accelerated and no-response period of mivacurium was prolonged in patients with end-stage renal failure undergoing dialysis therapy. End-stage renal failure prolonged the no-response period and duration of action of vecuronium and rocuronium after repeated incremental doses, but did not alter those attributed to atracurium.目的　研究终末期肾衰患者维库溴铵、阿曲库铵、美维松和罗库溴铵的药效。方法　 4 6例作肾移植术的终末期肾衰患者和 5 3例肾功能正常的患者分别给予维库溴铵、阿曲库铵、美维松和罗库溴铵。用四个成串刺激刺激尺神经 ,监测拇内收肌肌颤搐。结果　肾衰组维库溴铵、阿曲库铵和美维松的起效增快或有增快趋势 ,罗库溴铵的起效在两组间无显著性差异。阿曲库铵的无反应期、作用持续时间和恢复在两组间无差异。美维松的作用持续时间和恢复在两组间无显著性差异 ,但是肾衰组美维松的无反应期显著延长。肾衰组维库溴铵和罗库溴铵初量的无反应期和作用持续时间与肾功能正常组无明显差异 ;然而 ,多次间断追加后 ,肾衰组维库溴铵和罗库溴铵的无反应期和作用持续时间随追加次数增多而延长或有逐渐延长的趋势。结论　本研究的四个肌松药均能安全地运用于终末期肾功能衰竭患者。长期透析治疗的终末期肾衰患者肌松药的起效时间可能缩短 ,美维松的无反应期延长。终末期肾衰患者多次追加维库溴铵和罗库溴铵后 ,其时效延长 。

关 键 词：Anesthesia  General Kidney Transplantation Adult Androstanols ATRACURIUM Female Humans ISOQUINOLINES Male Middle Aged Neuromuscular Blocking Agents SUCCINYLCHOLINE Time Factors Vecuronium Bromide 

分 类 号：R614[医药卫生—麻醉学]