急性高容量血液稀释对全麻患者顺式阿曲库铵药效学的影响

目的 探讨急性高容量血液稀释(AHH)对全麻患者顺式阿曲库铵药效学的影响.方法 择期腹部手术患者印例,年龄18～60岁,ASAI或Ⅱ级,随机分为对照组(C组)和AHH组,每组30例,各组按顺式阿曲库铵首剂量(首剂量分别为30、40、50μg/kg,总用量100 μg/kg)分为3个亚组,每亚组10例.采用TOF-Wateh~(R)SX肌松监测仪监测神经肌肉阻滞情况.AHH组经30～40 min静脉输注6%羟乙基淀粉130/0.4 15 ml/kg行血液稀释,AHH后各亚组分别给予首剂量顺式阿曲库铵,当T_1达最大抑制后再注入余量.记录肌松起效时间、临床肌松作用时间、体内作用时间及恢复指数.采用概率单位法计算T_1抑制50%、90%、95%时顺式阿曲库铵的用量(ED_(50)、ED_(90)、ED_(95).结果 与C组比较,AHH组顺式阿曲库铵ED_(50)、ED_(90)、ED_(95)升高,肌松起效时间延长,临床肌松作用时间及体内作用时间缩短(P<0.05或0.01),恢复指数差异无统计学意义(P>0.05).结论 AHH可降低顺式阿曲库铵的肌松效应.

Influence of acute hypervolemic hemodilution on pharmacodynamics of cisatracurium in patients undergoing general anesthesia

Objective To investigate the influence of acute hypervolemic hemodilution (AHH) on pharmacodaynamics of cisatracurium in patients undergoing general anesthesia. Methods Sixty ASA Ⅰ or Ⅱ patients aged 18-60 yr scheduled for major abdominal surgery under general anesthesia were randomly allocated into 2 groups (n = 30 each): control group and AHH group. Each group was further divided into 3 subgroups according to the initial dose of cisatracurium (30, 40, 50 μg/kg) . The radial artery and right internal jugular vein were cannulated. BP, HR, CVP, SpO_2, P_(ET) CO_2 and body temperature were continuously monitored. The response of left adductor pollicis muscle to TOF stimulation of ulna nerve was monitored using TOF- Watch~R SX (Organon). Both groups received 10 ml/kg multiple electrolyte solution (plasma-Lyte A) during induction of anesthesia. In group AHH 15 ml/kg 6% hydroxyethyl starch (HES) 130/0.4 solution was infused via internal jugular vein over 30-40 min in addition to plasma-Lyte A. Five minutes after completion of plasma-Lyte A or HES, cisatracurium 30, 40 or SO fig/kg was injected iv in the respective subgroups. After the maximal T_1 block was achieved, the second dose was given to reach a total dose of 100 μg/kg. The onset time, duration of clinical action, total duration of action and recovery index were recorded. The doses for 50% , 90% and 95% T_1 depression (ED_(50), ED_(90), ED_(95)) were calculated by Probit method. Results The ED_(50), ED_(90), ED_(95) of cisatracurium were significantly higher in AHH group than in control group. The onset time of cisatracurium was significantly longer but clinical and total duration of action was significantly shorter in AHH group than in control group. There was no significant difference in recovery index between the two groups. Conclusion AHH can decrease the potency of cisatracurium.