中国临床药学杂志

目的观察吸入1.3倍最低有效肺泡浓度(MAC)七氟烷和地氟烷麻醉下对老年患者术中罗库溴铵持续输注速率的影响。方法全麻下行择期手术的老年患者60例,ASAⅠ~Ⅱ级。随机均分为3组,每组20例。3组开始均采用靶控输注丙泊酚(血浆浓度2⁴ mg·L-1)诱导和维持麻醉,静注0.6 mg·kg-1罗库溴铵气管插管。采用TOF-Watch SX肌松监测仪行拇指内收肌肌松监测,待T₁恢复5%开始输注罗库溴铵,调节输注速率始终维持T₁值8%~10%,稳定5 min时为初始状态。随即七氟烷(S)组和地氟烷(D)组停止输注丙泊酚,分别吸入七氟烷和地氟烷并使呼气末浓度稳定于1.3 MAC,对照(P)组继续输注丙泊酚。记录3组随后罗库溴铵输注速率,停肌松药后Tl恢复至25%所需时间,Tl从25%恢复至75%所需时间(恢复指数)及TOFr(T4/T₁)恢复至90%所需时间。结果 3组患者罗库溴铵初始状态输注速率相似,D组和S组输注速率随吸入时间延长而逐渐下降(P<0.05),而P组则未见明显改变;D组和S组初始状态后各时点罗库溴铵输注速率均显著低于P组(P<0.05);D组初始状态后50 min内各时点罗库溴铵输注速率均低于S组(P<0.05),而50~70 min间差异则无统计学意义。与P组比较,D组和S组患者停药后T₁恢复至25%时间、T_125%恢复至75%时间和TOFr恢复至90%时间均显著缩短(P<0.05);与S组比较,D组上述肌松恢复时间更短(P<0.05)。结论吸入1.3MAC七氟烷和地氟烷均能显著降低老年患者罗库溴铵持续输注速率,一定时间内地氟烷的该作用强于七氟烷,且肌松恢复更迅速。

AIM To observe the influences of sevoflurane and desflurane on continuous infusion rate of rocuronium in elderly patients. METHODS A total of 60 elderly patients( ASA Ⅰ-Ⅱ) undergoing elective surgery under general anesthesia were assigned randomly to 3 groups( group D,S,P) consisting of 20 patients each. At first all the patients adopted the target controlled infusion of propofol( plasma concentration 2-4 μg ·min^-1) for induction and maintenance of anesthesia,and accepted intravenous injection of 0. 6 mg·kg^-1 rocuronium for intubation. A TOF-Watch SX monitor was used to monitor the neuromuscular function of adductor pollicis muscle. When T₁ at 5%,intravenous infusion of rocuronium began and T₁ was maintained at 8%-10% all the time. The infusion rate of rocuronium was defined the initial state when T₁ at 8%-10% for 5 min. Then the infusion of propofol stopped in sevoflurane group( group S) and desflurane group( group D),sevoflurane and desflurane began to be inhaled respectively and maintained end-tidal concentration at 1. 3 MAC. But there were no changes in the control group( group P). The infusion rate changes of rocuronium were recorded,and the recovery times of muscle relaxant,which including the times of T₁ from 0 to 25%,T₁ from 25% to 75%( recovery index),TOFr from 0 to 90% were also recorded. RESULTS The initial infusion rate of rocuronium was similar in 3 groups,then gradually decreased in group D and group S when inhaled time prolonged( P < 0. 05),whereas there was no obvious change in the group P. Compared with group P,the recovery times of muscle relaxant,which including the times of T₁ from 0 to 25%,T₁ from 25% to 75%,TOFr from 0 to 90%,were significantly shortened in group D and group S( P < 0. 05). Compared with group S,the recovery times of muscle relaxant were shorter in group D( P < 0. 05). CONCLUSION The 1. 3 MAC sevoflurane and desflurane can significantly reduce continuous infusion rate of rocuronium in elderly patients. In a certain period of time the effect of desflurane is stronger than sevoflurane,and its muscle relaxant recover is more quick.