两种肌松药不同给药方案对老年肥胖患者的影响

目的：：探求两种肌松药不同给药方案行全身麻醉短小手术的老年肥胖患者最适合的肌松药用量。方法：选取2010年5月至2014年5月河北省承德医学院附属医院拟行短小手术的全身麻醉老年肥胖患者(年龄60~70岁,BMI>28kg / m2)60例,随机分为四组(n ＝15)：顺苯磺酸阿曲库铵净体重组(S1组),顺苯磺酸阿曲库铵真实体重组(S2组)；维库溴铵净体重组(W1组),维库溴铵真实体重组(W2组)；30例正常体重(BMI20~24kg / m2)老年患者为对照组,15例顺苯磺酸阿曲库铵(NS 组),15例维库溴铵(NW 组)。记录肌松药用量、起效时间、四个成串刺激从0％恢复到25％的时间、从25％恢复到75％的时间、从75％恢复到90％的时间。结果：S1组、NS 组与 S2组的顺苯磺酸阿曲库铵用量、TOF恢复25％的时间、从25％恢复至75％的时间差异有统计学意义(P<0.05)。 W1组、NW 组与 W2组的维库溴铵用量、TOF 恢复25％的时间、从25％恢复至75％的时间差异有统计学意义(P<0.05)。起效时间、TOF 从75％恢复至90％的时间六组患者差异均无统计学意义(P>0.05),S1组的 TOF 恢复25％的时间、从25％恢复至75％的时间与 W1组比较差异有统计学意义(P<0.05)。结论：老年肥胖患者按净体重给予2倍 ED95的非去极化肌松药,在相同的时间同样能满足气管插管,其肌松维持续时间明显缩短,肌松药用量明显减少。而且顺苯磺酸阿曲库铵对老年患者代谢更快。

The Effects on Different Administration Regimens of Two Kinds of Muscle Relaxants in Elderly Obese Patients

Objective: To investigate the proper dosage of two kinds of muscle relaxants with different administration regimens in elderly obese patients for short-time surgery. Methods: 60 elder obese patients un-dergoing a short-time surgery after general anesthesia from May 2010 to May 2014 in the Affiliated Hospital of Chengde Medical College were randomized into four groups (n = 15) (body mass index >28 kg / m2 and aged 60-70 yr): Lean body weight group of Atracurium (S1 ); real body weight group of atracurium (S2 ); Lean body weight group of vecuronium ( W1 ); real body weight group of vecuronium ( W2 ). thirty normal body weight patients (BMI 20-24 kg / m2 ) were served as control group(N): Fifteen of atracurium (NS); Fifteen of vecuronium (NW). The onset time, the duration of 25%, the duration of 25 ~ 75%, the duration of 75 ~90% and dose were recorded. Results:The duration of 25%, the duration of 25~75%, and dose are longer in S2 group compared with S1 group and NS group (P<0.05). The duration of 25%, the duration of 25 ~ 75%, and dose are longer in W2 group compared with W1 group and NW group (P<0.05). The duration of 25% and the duration of 25~75% are longer in W1 group compared with S1 group (P<0.05).There are no significant difference in the onset time and the duration of 75~90% among groups. Conclusion: The duration of action of muscle-relaxants are significantly prolonged when the dose is calculated according to real body weight in eldly obese patients. In contrast, when muscle-relaxants are dosed according to the lean body weight in eldly obese patients, the clinical duration of action is shorter and the dose of muscle-relaxants is decreased.