米库氯铵用于早期肝硬化患者肌松效应和安全性研究

目的 观察米库氯铵在肝硬化患者全身麻醉中的肌松效应和安全性,为临床用药提供指导. 方法 选择择期行腹腔镜手术患者,分为肝硬化组(C组,32例)、非肝硬化组(N组,25例).肌松监测采用四个成串刺激(train of fourstimulation,TOF).米库氯铵插管剂量0.2 mg/kg,四个成串刺激比值(train of four stimulation ratio,TOFr)(T4:T1)为0时进行气管插管,肌松开始恢复时(TOFr＞0)开始泵注,初始速度0.6 mg· kg-1·h-1,TOFr为0时改为0.3 mg·kg-1·h-1,两组分别于缝皮结束前约30、20 min停止泵注.重点观察血浆胆碱酯酶(plasma cholinesterase,PchE)活性、组胺浓度、MAP、HR变化以及米库氯铵起效时间、首剂作用时间、TOFr恢复时间、停药至拔管时间、恢复指数. 结果 两组患者PchE活性(4 304±901)、(6 227±1 289) U/L]比较,差异有统计学意义(P＜0.05),两组患者组胺浓度、MAP、HR在静脉注射米库氯铵前后差异无统计学意义(P＞0.05);所有患者在静脉注射米库氯铵前、静脉注射后5 min、静脉注射后10 min组胺浓度分别为(0.196±0.020)、(0.238±0.021)、(0.278±0.024) μg/L,3个时间点间比较差异有统计学意义(P＜0.05).插管条件指标均≤2分.两组患者米库氯铵起效时间、恢复指数比较,差异无统计学意义(P＞0.05).两组患者首剂作用时间(20±4)、(16±3) min]比较,差异有统计学意义(P＜0.05);两组患者TOFr恢复至75％的时间(35±10) min和(24±5) min]比较,差异有统计学意义(P＜0.05);两组患者停药至拔管时间(35±9)、(24±7) min]比较,差异有统计学意义(P＜0.05). 结论 米库氯铵用于早期肝硬化患者全身麻醉,血浆组胺浓度轻微上升,对MAP、HR无明显影响,插管条件满意,肌松效果好,肌松恢复快.与非肝硬化患者比较,肌松恢复时间稍长,但与其他肌松药比较,仍具有明显优势,且米库氯铵不直接通过肝代谢,可减轻肝对药物代谢的负担,推荐用于肝硬化患者.

Muscle relaxation effect and safety of mivacurium in patients with early hepatocirrhosis

Objective To observe muscle relaxation effect and safety of mivacurium in hepatocirrhosis patients,and provide a guidance in its clinical application.Methods Candidates for elective laparoscopic surgery were divided into a hepatocirrhosis group (group C,n=32) and a non hepatocirrhosis group (group N,n=25).Muscular relaxation monitor was applied with a train of four stimulation (TOF).The intubation dosage was 0.2 mg/kg.Tracheal intubation was performed when train of four stimulation ratio(TOFr,T4:T1) was 0,and pump infusion of mivacurium was started when muscle relaxation began to recover (TOFr＞0) with a velocity of 0.6 mg·kg-1·h-1,which was switched to 0.3 mg·kg-1h-1 and then stopped in 30 min and 20 min prior to end of suturing in group C and group N respectively.The key parameter included plasma cholinesterase (PchE) activity,histamine concentration,variation of MAP,HR,onset time of mivacurium,acting duration of the first dose,time of TOFr recovery,time from drug withdrawal to extubation,and recovery index.Results The PchE activity were (4 304±901) U/L and (6 227±1 289) U/L in two groups (P＜0.05).The histamine concentration,MAP and HR didn't have significant differences before and after injection of mivacurium(P＞0.05).The mean histamine concentrations of all patients were (0.196±0.020),(0.238±0.021),(0.278±0.024) μg/L prior to intravenous injection of mivacurium and in 5 min and 10 min post to injection,there were significant differences between the three times points (P＜0.05).All indicators for intubation conditions were no more than 2 points.The onset time of mivacurium,recovery index didn't have no significant differences between the two groups (P＞0.05).The duration of the first dose were (20±4) mfin and (16±3) min respectively,the recovery of TOFr to 75％ were (35±10) min and (24±5) min,time from drug withdrawal to extubation were (35±9) min and (24±7) min,and there were significant differences between the two groups (P＜0.05).Conclusions The plasma histamine concentration increase slightly without significant iufluence on MAP and HR,with satisfactory intubation conditions,good muscle relaxation and fast recovery frown muscle relaxation when mivacurium was applied in patients with early hepatic cirrhosis.Compared with non hepatic cirThosis patients,the time of muscle relaxation recovery induced by mivacurium was longer in hepatic cirrhosis patients,but compared with other muscle relaxant,it still had obvious advantages.Because mivacurium didn't directly depend on the liver to metabolize,so it could reduce the burden of liver on drug metabolism.It is recommended to be applied in patients with early hepatic cirrhosis.