血液稀释对顺式阿曲库铵药代学及药效学影响的研究

目的：研究血液稀释下顺式阿曲库铵药代学及药效学变化,为其血液稀释时的合理使用提供参考依据.方法：择期骨科手术患者90例,ASA Ⅰ～Ⅱ级,35～60岁.随机分为3组（n=30）：A组行急性等容血液稀释（ANH）;B组行急性高容血液稀释（AHH）;C组为对照组,常规输血输液.每组患者再随机分为3个亚组（n=10）,顺式阿曲库铵剂量分别为0.1、0.2、0.3 mg/kg.常规麻醉诱导后,静注相应剂量顺式阿曲库铵后气管插管.观察各组患者的肌松效应及血药浓度变化,并计算其药代学参数.结果：同等剂量下B组肌松起效时间显著延长（P＜0.05）;三组患者起效时间缩短,成串刺激（TOF）无反应期、肌松维持时间、肌松体内时间随剂量增大而延长（P＜0.05）;A、B组血液稀释后血药浓度均呈剂量正相关性下降,B组下降更显著.血液稀释组t1/2α延长,Vc显著增大（P＜0.05）,其中AHH组Vc增大约1倍.结论：AHH下使用顺式阿曲库铵时,应适当增加剂量;而ANH时可不调整剂量.

Effect of hemodilution on the pharmacokinetics and pharmacodynamics of cis-atracurium

AIM：To compare the changes of pharmacokinetics and pharmacodynamics of cisatracurium administered in different methods of hemodilution to provide a reference for clinical anesthesia.METHODS：Ninety elective orthopedic surgery patients,ASA Ⅰ-Ⅱ,35 to 60 years old,were randomized into three groups by the different treatment methods in preoperative transfusion （n=30 each）：group A acute normovolemic hemodilution （ANH）,group B acute hypervolemic hemodilution （AHH） and control group （group C）.Each group was divided into three subgroups（n=10 each） with the corresponding loading dose of cis-atracurium （0.1,0.2,0.3 mg/kg）.General anesthesia was induced after intravenous doses corresponding cisatracurium after tracheal intubation.And then,we observed in each group of patients with muscle relaxant effects and changes in plasma concentration and calculated the pharmacokinetic parameters.RESULTS：The onset time of muscle relaxation was significantly longer in group B of the same dose （P〈0.05）.The TOF responses of free,the duration of neuromuscular block,and the body time were increased while the onset time accelerated as the dose prolonged （P 〈 0.05）.Hemodilution group significantly decreased serum concentrations positively correlated with the dose.And the reduction of group B was more pronounced.t1/2α and Vc increased significantly in group A and B （P〈0.05）.And Vc in group B doubled.CONCLUSION：The dose of cis-atracurium in AHH should be appropriately increased,which could be maintained while in ANH.