罗库溴铵采用靶浓度控制输注给药与按TOF监测调控输注给药的药效学比较

目的用靶浓度控制输注法(TCI)与按4个成串刺激监测(TOF)调控持续增长静脉泵入法,对罗库溴铵的药效学进行比较,探讨罗库溴铵TCI的可行性和优劣性。方法选择30例ASAⅠ~Ⅱ级,无神经肌肉疾患,拟在全麻下行择期手术的女性患者,随机分成罗库溴铵靶浓度控制输注组(Ⅰ组,15例)和按TOF监测调控输注组(Ⅱ组,15例),以TOF刺激方式,监测拇内收肌的颤搐反应作为肌松效果的判定指标。Ⅰ组应用TCI技术,诱导时效应室靶浓度为9 mg/L,达最大阻滞时将效应室靶浓度调至4 mg/L,维持期依据临床指标调节靶浓度,同时记录TOF监测结果,但不作为调整肌松药用量的指标;Ⅱ组应用TOF监测技术诱导时采用单次推注0.6 mg/kg(2ED95)罗库溴铵,待肌松恢复至T1/Tc达10%时开始持续泵注,调节泵注速度使T1/Tc在10%~20%之间。记录2组神经肌肉阻滞监测的显效时间、起效时间、维持时间、恢复指数,并记录罗库溴铵在各阶段的用量,插管条件以及TOF监测情况。以全凭静脉麻醉(TIVA)进行麻醉诱导和维持。全部病例在肌松恢复期不予拮抗,使其自然恢复。当TOF恢复至T1/Tc≥75%时结束肌松监测,呼吸恢复满意后拔管。结果2组罗库溴铵的起效时间分别为(73.3±26.6)s和(88.7±36.2)s,没有统计学差异,但I组稍快于Ⅱ组。诱导用药量分别为(0.86±0.09)mg/kg和(0.60±0.00)mg/kg,差异具有统计学意义(P<0.01)。Ⅰ组的单位时间维持用药量为(6.48±2.28)μg/(kg.min),Ⅱ组为(8.23±2.35)μg/(kg.min),差异有统计学意义(P<0.05)。Ⅰ组的平均维持靶浓度为4.47 mg/L(4~5.5 mg/L)。维持阶段的TOF监测,I组T1/Tc(%)在0~2之间2例,在2~20之间7例,在20~50之间6例,T4/T1(%)均在0~25之间;Ⅱ组T1/Tc(%)均在10~20之间,T4/T1(%)均在0~25之间。停药后2组的肌松恢复过程无明显差异。2组的总平均用药量无明显差异。结论靶控输注罗库溴铵可安全用于临床,在效应室靶浓度为9 mg/L时诱导可以在70 s左右顺利进行气管插管,应用4.5 mg/L效应室靶浓度可使60%的患者维持满意的肌松效果。停药后恢复指数为(19.6±8.4)min。由于仍未解决个体差异问题,尚不能完全取代TOF监测给药。

Comparison of Pharmacodynamics of Rocuronium in Administration by Target-controlled Infusion versus Continuous Infusion with TOF Monitor

Objective The study was designed to compare the pharmacodynamics of rocuronium administered by target-controlled infusion(TCI) and continuous infusion and to investigate the feasibility of target-controlled infusion of rocuronium.Methods Thirty female adult patients,ASA Ⅰ^Ⅱ,without any neuromuscular disease,undergoing elective surgery under general anesthesia,were randomly divided into two groups with fifteen patients each.In group Ⅰ patients received rocuronium by TCI and in group Ⅱ by continuous infusion.The responses of adductor pollicis to train-of-four(TOF) stimulation of ulnar nerve were monitored.The onset time,the time of maximal neuromuscular blockade,the duration of neuromuscular blockade,the spontaneous recovery time,dosages of rocuronium and intubations condition were recorded.Total intravenous anesthesia(TIVA) was used for both induction and maintenance of anesthesia.Patients received no antagonists for reversal of neuromuscular blockade and recovered spontaneously.Neuromuscular blockade monitoring ended when TOF ratio(T₁/Tc)≥75%.The patients were extubated when ventilation was satisfactory.Results The two groups were well-matched with regard to age,weight,height and duration of operation.The mean onset times were(73.3±26.6)s in group Ⅰ versus(88.7±36.2)s in group Ⅱ(P>0.05).The mean dosages of induction were(0.86±0.09)mg/kg in group Ⅰ versus(0.60±0.00)mg/kg in group Ⅱ(P<0.01).The mean target concentration of maintenance was 4.47mg/mL in group Ⅰ.There was no significant difference in the recovery time between the two groups.The total dosages between the two groups.Conclusion Target-controlled infusion of rocuronium can be used safely in clinical practice.The suggested effect-site concentration of induction is 9 mg/mL,at which intubation is accomplished 70 s after induction.The suggested effect-site concentration of maintenance is 4.5 mg/mL.TCI can provide satisfactory muscle relaxation,but is not advantageous over continuous infusion.