七氟烷对糖尿病和非糖尿病患者罗库溴铵肌松效应影响的比较

目的 比较七氟烷对糖尿病和非糖尿病患者罗库溴铵肌松效应的影响.方法 择期腹部手术患者60例,年龄45～64岁,ASAⅡ级,其中Ⅱ型糖尿病患者30例,随机分为2组(n=15):异丙酚组(PD组)和七氟烷组(SD组);非糖尿病患者30例,随机分为2组(n=15):异丙酚组(PN组)和七氟烷组(SN组).静脉注射咪达唑仑、异丙酚和芬太尼行麻醉诱导后启动肌松监测,PD组和PN组静脉注射罗库溴铵0.6 mg/kg后气管插管,静脉输注异丙酚维持麻醉;SD组和SN组1%地卡因充分表面麻醉后气管插管.吸入七氟烷(呼气末浓度1.71%)10 min后静脉注射罗库溴铵0.6 mg/kg,吸入七氟烷(呼气末浓度1.71%)维持麻醉.记录肌松起效时间、维持时间和恢复指数.于静脉注射罗库溴铵后10、20、30、40、50、60、70、80、90、100、110、120 min时记录T1/T0比值及TOF比值(T4T1比值).结果 PN组与PD组、SN组与SD组、PD组与SD组间罗库溴铵起效时间、维持时间比较差异无统计学意义(P>0.05).与SN组和PD组比较,SD组恢复指数延长(P<0.05).静脉注射罗库溴铵后60～120 min,SD组T1/T0比值和TOF比值较PD组降低(P<0.05);静脉注射罗库溴铵后80～120 min,SD组TOF比值较SN组降低(P<0.05).结论 与非糖尿病患者相比,七氟烷对糖尿病患者罗库溴铵肌松效应的强化作用进一步增强.

Comparison of effects of sevoflurane on neuromuscular blockade induced by rocuronium in patients with and without diabetes mellitus

Objective To compare the effects of sevofturane on neuromuscular block induced by rocuronium in the patients with or without diabetes mellitus. Methods Thirty diabetic and 30 non-diabetic ASA Ⅱ patients aged 45-64 yr scheduled for elective middle or lower abdominal surgery were studied. Both diabetic and non-diabetic patients were randomly assigned to one of 2 groups (n = 15 each): propofol group (group P) and sevoflurane group (group S). All patients were anesthetized with midazolam, propofol and fentanyl. After loss of consciousness tracheal intubation was performed after rocuronium 0.6 mg/kg and anesthesia was maintained with iv propofol infusion in group P. In group S tracheal intubation was performed under topical anesthesia with 1% amethacaine injected through cricotbyroid membrane. Anesthesia was maintained with sevoflurane inhalation (end-tidal concentration 1.71 %). Rocuronium 0.6 mg/kg was given iv at 10 min after inhalation of sevoflurane was started. Neuromuscular function was assessed by accelerograpby (TOF-Watch SX, Orgnnon, Holland). TOF stimulation of ulnar nerve was used. The onset time, duration of action and recovery index (for T1 to return from 25% to 75% of the control twitch) were recorded. The T1/T0 and TOF (T4/T1) ratios were recorded at 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 110 and 120 min after a single bolus of rocuronium. Results There was no significant difference in onset time and duration of action between diabetic and non-diabetic patients in both propofol and sevoflurane groups. The recovery index was significantly higher in diabetic patients than in non-diabetic patients in group S. The recovery index was significantly higher in group S than in group P in diabetic patients. The ratios of T1/T0 and TOF were significantly lower in group S than in group P in diabetic patients during 60-120 min after a single bolus of rocuronium. The TOF ratio was significantly lower in diabetic patients than in non-diabetic patients in group S during 80-120 min after a single bolus of rocuronium. Conclusion The effect of sevoflurane on rocuronium-induced neuromuscular block is enhanced in diabetic patients compared with non-diabetic patients.