顺苯磺阿曲库铵应用于不同年龄患者的药效动力学研究

目的 探讨顺苯磺阿曲库铵应用于不同年龄患者的肌松效果.方法 择期手术患者180例,ASA分级Ⅰ～Ⅱ级,按年龄分为50～60岁组(Ⅰ组)、61～70岁组(Ⅱ组)和70岁以上组(Ⅲ组),每组再分别按2倍95%有效量(ED95)或3倍ED95分组,共六组(Ⅰ2、Ⅰ3、Ⅱ2、Ⅱ3、Ⅲ2、Ⅲ3组),每组各30例.连续监测ECG、SpO2、呼气末二氧化碳分压(PETCO2)、HB及拇内收肌诱发肌颤搐反应的变化.患者入睡后开启电刺激,将肌颤搐的高度调节至100%,稳定后单次静脉注入2倍ED95或3倍ED95的顺苯磺阿曲库铵,待四个成串刺激(TOF)的T1为0时行气管插管,并对插管条件进行评级.观察阻滞起效时间、TOF无反应期、阻滞维持时间、肌松恢复时间及体内作用时间.结果 Ⅰ3、Ⅱ3、Ⅲ3组患者插管条件为优的比率(93%、90%、80%)明显高于Ⅰ2、Ⅱ2、Ⅲ2组(67%、60%、60%),P<0.05.Ⅰ3、Ⅱ3、Ⅲ3组阻滞起效时间显著短于Ⅰ2、Ⅱ2、Ⅲ2组(P<0.05),且Ⅰ2组和Ⅰ3组较其他组阻滞起效时间明显缩短(P<0.05).Ⅰ3、Ⅱ3、Ⅲ3组的TOF无反应期、阻滞维持时间、体内作用时间明显长于Ⅰ2、Ⅱ2、Ⅲ2组(P<0.05);Ⅱ2、Ⅲ2组TOF无反应期、阻滞维持时间、体内作用时间明显短于Ⅰ2组(P<0.05);Ⅱ3、Ⅲ3组TOF无反应期、阻滞维持时间、体内作用时间明显短于Ⅰ,组(P<0.05);但是肌松恢复时间各组比较差异均无统计学意义.结论 顺苯磺阿曲库铵3倍ED95应用于不同年龄患者均是安全有效的,其起效和插管条件均优于2倍ED95.肌松恢复时间与剂量、年龄关系不大.增龄对单次静脉注射顺苯磺阿曲库铵的药效学无明显影响.

Pharmacodynamics of cisatracurium besylate in different age patients

Objective To study the pharmacodynamics features of cisatracurium besylate in differ-ent age patients. Methods One hundred and eighty patients were randomized to group Ⅰ (50-60 years old),group Ⅱ (61-70 years old)and group Ⅲ (above 70 years old).Each group was subdivided according to the dose of cisatracurium besylate, 0.10 mg/kg (2ED95)or 0.15 mg/kg (3ED95) into group Ⅰ2, Ⅰ3, Ⅱ2, Ⅱ3,Ⅲ2, Ⅲ3(n = 30).ECG, SpO2, PETCO2, HR and neuromuscular blockade were monitored. Intubation conditions were assessed when T1 was zero after cisatracurium besylate administer ration using a 4-part scale.The onset time, TOF no reaction time, duration time, recovery lime and hemodynamic response time were recorded. Re-sults The onset times of group Ⅰ3, Ⅱ3 and Ⅲ3 were significantly shorter than those of group Ⅰ2, Ⅱ2 and Ⅲ2 (P < 0.05).The percentages of patients with excellent intubation condition in group Ⅰ3, Ⅱ3 and Ⅲ3 were 93%, 90%, and 80%, which were markedly higher than those in group Ⅰ2, Ⅱ2 and Ⅲ2 (67%, 60%, 60%). TOF no reaction time and duration time were longer in group Ⅰ3, Ⅱ3 and Ⅲ3 than those in group Ⅰ2, Ⅱ2 and Ⅲ2. There was no significant difference in muscle chalasis among the six groups. Conclusions Cisatracuri-um besylate 0.15 mg/kg produces quicker onset time and acceptable intubation conditions in the different age patients than 0.10 mg/kg. Recovery time is independent on the dosage and age. Aging has no influence on the phannacodynamics of single injection of cisatracurium besylate.