不同体重指数对顺苯磺酸阿曲库铵药效学的影响

目的探讨不同体重指数对顺苯磺酸阿曲库铵药效学的影响。方法全身麻醉择期手术患者40例,ASAⅠ~Ⅲ级,按体重指数的不同分为四组:偏瘦组(Ⅰ组),BMI18.5 kg/m2;正常体重组(Ⅱ组),BMI 18.6~24.9 kg/m2;超重组(Ⅲ组),BMI 25.0~30.0 kg/m2;肥胖组(Ⅳ组),BMI≥30.0 kg/m2。四组均按实际体重分别给予0.15 mg/kg(3 ED95)顺苯磺酸阿曲库铵。使用加速度肌松监测仪(TOF-Watch誖SX)行TOF监测拇内收肌肉阻滞(NMB)程度。麻醉采用全凭静脉麻醉诱导及维持。当T1达最大抑制值(T1降至最低值并重复3次以上不变时)时进行气管插管。记录起效时间(从肌松药注毕至T1达到最大抑制值的时间)、临床作用时间(注药结束到T1恢复至25%的时间)、药理作用时间(注药结束到T1恢复至90%的时间)、恢复指数(T1从25%恢复到75%的时间)和气管插管条件评级。结果体重指数与3倍ED95顺苯磺酸阿曲库铵的临床作用时间呈线性相关,回归方程为Y=1.531X+8.479(R2=0.628,P0.01);BMI与3倍ED95顺苯磺酸阿曲库铵药理作用时间呈线性相关,回归方程为Y=1.954X+15.049(R2=0.585,P0.01)。4组患者的临床作用时间和药理作用时间差异有统计学意义(P0.05),而起效时间、恢复指数和插管条件差异均无统计学意义(P0.05)。结论顺苯磺酸阿曲库铵按实际体重3倍ED95给药,随着患者的体重指数增高,其临床作用时间和药理作用时间亦随之延长,体重指数是影响该药恢复时间的重要因素之一。

Effect of body mass index on neuromuscular blockage induced by cisatracurium

Objective To observe the effect of body mass index on neuromuscular blockage induced by cisatracurium. Methods Forty ASA Ⅰ - Ⅲ patients undergoing elective surgery under total intravenous anesthesia were enrolled in this study. All patients were divided into 4 groups： group I （slim） with BMI 〈 18.5 kg/m2; group Ⅱ （normal） with BMI 18.6- 24.9 kg/m2; group Ill （overweight） with BMI 25.0-30.0 kg/m2; group Ⅳ （obesity） with BMI ≥30.0 kg/m2. Four groups received cisatracurium 0.15 mg/kg according to real body weight. The responses of adductor pollicis to train of four （TOF） stimulation of ulnar nerve were monitored by TOF-Watch SX muhifunction monitor. General anaesthesia was induced and maintained with target-controlled infusion. Intubation was attempted when T1 reached maximal inhibition （T2 minimize repeated more than 3 times）. The onset time （time from end of bolus injection to 100% twitch depression）, intubation conditions, clinical duration （time from the end of bolus injection to recovery of twitch tension to 25% of control）, pharmacological duration （time from the end of bolus injection to recovery of twitch tension to 90% of control） and recovery index （the time lapse from 25% to 75% of recovery of T1） were recorded. Results A significant correlation between clinical duration and BMI （RZ=0.628 ,P〈0.01 ） was found by linear regression analysis. A significant correlation was also found between pharmacological duration and BMI（R2=0.585,P〈0.01）. Conclusion In adult patients, the clinical duration and pharmacological duration of cisatracurium increases with BMI when the drug is administered according to actual body weight.