肝功能障碍病人对罗库溴铵肌松时效的影响  

Neuromuscular blocking effect of rocuronium in patients with liver dysfunction

作　　者：李友清[1] 郭曲练[1] 

机构地区：[1]中南大学湘雅医院麻醉科,长沙市410008

出　　处：《中华麻醉学杂志》2003年第11期816-818,共3页Chinese Journal of Anesthesiology

摘　　要：目的 研究肝功能障碍对罗库溴铵肌松时效的影响。方法 选择无神经肌肉疾患、肾功能正常、在全麻下行择期肝胆手术的病人40例,其中20例肝功能正常,ASAⅠ～Ⅱ级,为对照组(A组),另20例有明显梗阻性黄疸的肝功能障碍(ASAⅢ级)病人,为肝功能障碍组(B组)。两组病人术前均未用对肌松有影响的药物。用加速度仪监测拇内收肌收缩反应,观察罗库溴铵0.6mg·kg^(-1)时两组病人肌松时效的差异。结果 A、B两组起效时间分别为(63±19)s和(70±21)s,差异不明显;临床时效分别为(41±16)min和(67±29)min,P<0.05;恢复指数分别为(9.4±2.0)min和(10.9±2.5)min,差异不明显。结论 梗阻性黄疸的肝功能障碍病人,罗库溴铵的临床作用时效延长,但起效时间和恢复无明显改变。Objective To investigate the change in neuromuscular blocking effect of rocuronium induced by liver dysfunction. Methods Forty patients undergoing elective liver and biliary tract operation under general anesthesia were divided into 2 groups : (A) control group included 20 patients with normal liver function and (B) liver dysfunction group included 20 patients with obstructive jaundice. The premedication consisted of phenobarbital 0.lg and atropine 0.5 mg. Anesthesia was induced with midazolam 0.1 mg·kg-1,fentanyl 6μg·kg-1 and etomidate 0.3 mg·kg-1.The neuromuscular function was monitored by TOF stimulation of the ulnar nerve using accelerograph (Biometer).Rocuronium 0.6 mg·kg-1 was administered iv via the vein in the upper arm.The patients were intubated when T1 was 95% depressed and mechanically ventilated.PETCO2 was maintained at 35-40 mm Hg.The onset time (from the end of injection to T1=0),clinical duration of action (from the end of injection to 25% recovery of T1) and recovery index (T1 from 25% to 95% ) were recorded.MAP, HR and SpO2 were recorded before and at 5 and 10 min after rocuronium injection.Results The demographic data including sex, age and weight were comparable between the two groups. The onset time was (63±19) s in group A and (70±21) s in group B.The difference was not statistically significant. The clinical duration of action was (41±16) min in group A and (67±29) min in group B (P<0.05).The recovery index was (9.4± 2.0) min in group A and (10.9±2.5) min in group B (P>0.05).Conclusion Liver dysfunction induced by obstructive jaundice prolongs the clinical duration of action,but does not significantly affect the onset time of and recovery from rocuronium.

关 键 词：肝功能障碍 罗库溴铵 肌松时效 影响 雄甾烷醇类 神经肌肉阻滞 胆汁郁积 

分 类 号：R614[医药卫生—麻醉学]