顺式阿曲库铵用于阻塞性黄疸患者的药效学研究

目的研究顺式阿曲库铵用于阻塞性黄疸患者静脉全身麻醉的安全性和肌松效应。方法将40例因阻塞性黄疸接受手术的患者(Child-Pugh B级)随机分为A1组(n=20)和A2组(n=20);将同期行腹部手术的40例肝功能正常患者随机分为B1组(n=20)和B2组(n=20)。麻醉诱导时A1、B1组患者及A2、B2组患者分别单次静脉注射2ED95或3ED95顺式阿曲库铵;用TOF-Watch SX加速度仪对前臂尺神经行4个成串(TOF)刺激来评估神经-肌肉阻滞程度。观察麻醉诱导前、后4组患者生命体征的变化、插管条件和肌松效应。结果 A1、A2组患者血清丙氨酸转氨酶(ALT)、总胆红素(TBIL)水平分别明显高于B1、B2组(P<0.05);A1、B1组患者气管插管条件评价为优的比率分别明显低于A2、B2组(P<0.05);相同诱导剂量时,A1、A2组患者肌松药起效时间分别与B1、B2组比较,差异均有统计学意义(P<0.05);诱导剂量由2ED95增至3ED95,肌松药起效时间明显提前(P<0.05);4组患者恢复指数的差异无统计学意义(P>0.05);麻醉期间患者均未出现组胺释放的不良反应。结论顺式阿曲库铵可安全地用于阻塞性黄疸患者的全身麻醉。

A pharmacodynamic study on cis-atracurium treatment for patients with obstructive jaundice

Objective To study the safety and muscle relaxation effect of cis-atracurium on patients with obstructive jaundice subjected to intravenous general anesthesia.Methods 40 patients with obstructive jaundice(Child-Pugh grade B) who accepted surgery were randomly divided into group A1(n=20) and group A2(n=20),and 40 patients with normal liver function who subjected to abdominal surgery in the corresponding period were randomly divided into B1(n=20) and group B2(n=20).Patients in group A1,B1 and group A2,B2 were administrated with single intravenous injection of 2ED95,3ED95 cis-atracurium,respectively,at the time of anesthesia induction.TOF-Watch SX acceleration instrument was employed to estimate the degree of neuromuscular blockade via train-of-four(TOF) stimulation of forearm ulnar nerve.Changes of vital signs,intubation conditions and muscle relaxation effect of patients before and after anesthesia induction were observed.Results Serum levels of alanine aminotransferase(ALT),total bilirubin(TBIL) of patients in group A1,B1 were significantly higher than those in group A2,B2,respectively(P<0.05),and the excellent ratios of endotracheal intubation conditions of patients in group A1,B1 were markedly lower than those in group A2,B2,respectively(P<0.05).Compared with the onset time of muscle relaxant between patients in group A1 and B1,group A2 and B2,respectively,when the same induction dose was administrated,the differences were both statistically significant(P<0.05).The onset time of muscle relaxant was obviously moved up when the induction dose had been increased from 2ED95 to 3ED95(P<0.05).The difference of recovery index among patients in four groups showed no statistically significant(P>0.05),and no adverse reactions of histamine release were found in patients during anesthesia.Conclusion Cis-atracurium can be safely used in patients with obstructive jaundice for general anesthesia.