罗库溴铵对老年病人的药效动力学影响  

Effects of pharmacodynamics of rocuronium in elderly patients

作　　者：周洁[1] 齐波[1] 王祥瑞[1] 杭燕南[1] 孙大金[1] 

机构地区：[1]上海第二医科大学附属仁济医院麻醉科,200001

出　　处：《中华麻醉学杂志》2003年第11期819-821,共3页Chinese Journal of Anesthesiology

摘　　要：目的 研究罗库溴铵对老年病人的肌松效应。方法 94例ASA Ⅰ～Ⅱ级的病人按年龄分为4组,Ⅰ组为对照组(28例,32～59岁),Ⅱ组(29例,60～69岁),Ⅲ组(27例,70～89岁)和Ⅳ组(10例,90～97岁)。四组病人均于全麻诱导时静注罗库溴铵0.6mg/kg,并进行四个成串刺激(TOF)肌松监测。术中持续静注罗库溴铵,用注射泵调控给药剂量,T_1维持10％～20％至手术结束。记录罗库溴铵起效时间、T_1为零时间、首次给药后T_110％恢复时间、停药后T_125％恢复时间以及每30min罗库溴铵用量。结果 (1)Ⅰ组病人罗库溴铵起效时间明显比其余三组长(P<0.01),Ⅳ组病人肌松起效时间快于Ⅱ组和Ⅲ组(P<0.01)。(2)Ⅰ组病人T_1为零时间明显比其余3组病人长(P<0.01),Ⅱ、Ⅲ组T_1为零时间相近(P>0.05),Ⅳ组病人则短于Ⅱ组和Ⅲ组(P<0.01)。(3)Ⅰ组和Ⅱ组首次给药后T_110％恢复时间和停药后T_125％恢复时间显著快于Ⅲ组和Ⅳ组(P<0.01)。(4)不同年龄组罗库溴铵用量不同,随年龄增加而减少(P<0.01)。结论 随着年龄的增长,尤其在高龄病人罗库溴铵起效时间,达最大效能时间增快、维持用量减少和肌松持续时间延长。Objective To investigate the characteristics of pharmacodynamics of rocuronium in elderly patients. Methods Ninety-four ASA Ⅰ - Ⅱ patients aged between 32-97 yr were divided into 4 age groups : group Ⅰ 32-59 yr(n=28);group Ⅱ 60-69 yr (n = 29);group Ⅲ 70-89 yr (n=27);group Ⅳ 90-97 yr (n=10).The patients were premedieated with intramuscular phenobarbital 0.lg and atropine 0.5 mg. Anesthesia was induced with midazolam, propofol and fentanyl. Tracheal intubation was facilitated with rocuronium 0.6 mg·kg-1.The patients were mechanically ventilated and PET CO2 was maintained between 35-45 mm Hg. Anesthesia was maintained with isoflurane 1 MAC and intermittent iv boluses of fentanyl. Rocuronium was continuously infused during operation to maintain T1 at 10%-20% control.Neuromuscular (N-M) function was monitored using TOF response measured by accelerography.(1) Onset time (time from end of rocuronium injection to 100% block of T4 ),(2) maximal effect (time from end of injection to 100% block of T1 ),(3) clinical duration (time from end of injection to 10% recovery of T1 ) ,(4) intubating condition,(5) the amount of rocuronium consumed every 30 min and (6) recovery time (time from termination of rocuronium infusion to recovery of T1 to 25% control) Results (1) The onset time and the time of maximal effect were significantly longer in group Ⅰ than those in other three groups.(2) The time of maximal effect in group Ⅳ was significantly shorter than that in group Ⅱ and Ⅲ (3)The recovery time in group Ⅰ and Ⅱ was significantly shorter than that in group Ⅲ and Ⅳ.(4) The amount of rocuronium consumed per 30 min was decreasing with increasing duration of infusion and age. Conclusion The duration of action of rocuronium is longer and less amount of rocuronium is needed when it is given to elderly patients.

关 键 词：罗库溴铵 老年人 药效动力学 雄甾烷醇类 神经肌肉阻滞 

分 类 号：R96[医药卫生—药理学]