终末期肾病患者顺式阿曲库铵量效关系测定

目的采用单次剂量注射法测定终末期肾病患者顺式阿曲库铵量效关系。方法选取接受肾移植的终末期肾病患者40例，按完全随机方法分为4组，每组10例，对4个剂量组患者按体重注射20、30、40、50μg／kg的顺式阿曲库铵。选取无神经肌肉病变的患者20例作为对照组，给予相同剂量的苯磺酸顺式阿曲库铵。记录每个患者最大抑制效应，并对最大抑制效应进行概率转换，对应的肌松药剂量进行对数转换，用直线回归方法建立顺式阿曲库铵的剂量-反应曲线。结果终末期肾病患者顺式阿曲库铵50％有效剂量（ED50）、75％有效剂量（ED75）、90％有效剂量（ED90）、95％有效剂量ED95分别为30．88、35．65、40．62、43．85μg/kg，无神经肌肉病变患者顺式阿曲库铵ED。ED。ED。ED。分别为35．37、42．22、49．60、54．55μg/kg，终末期肾病患者顺式阿曲库铵ED。明显低于无神经肌肉病变患者ED95（P〈0．01）。结论终末期肾病患者因周围神经病变累及神经肌肉接头可导致对肌松药的敏感性增加。

The measurement of dose-response curve of cisatracurium in patients with end-stage renal disease

Objective To determine the dose-response curve of cisatracurium in patients with end stage renal disease. Methods Forty patients with end stage renal disease were randomly divided into four groups（n=10）, the dose of eisatracurium were 20, 30, 40 or 50 μg/kg respectively. Twenty patients with normal neural and muscular function were randomly divided into four groups and received the same doses pattern. The dose-response curve was determined by single bolus of cisatracurium under midazolam-fentanyl intravenous anesthesia. Neuromuscular transmission monitoring was used to measure the block effect after injection of cisatracurium, and the responses were defined by terms of the percentages of maximum suppression in twitch response 1 of train of four of the adductor policies muscle. After logarithmic transformation, the dose-response curve of cisatracurium was then established by linear analysis. Results The ED50, ED75, ED90 and ED95 of cisatracurium in patients with end stage kidney disease were 30.88, 35.65, 40.62, 43.85 μg/kg, with normal neural and muscular function were 35.37, 42.22, 49.60, 54.55 μg/kg, respectively, the ED95 of cisatracurium in patients with end stage kidney disease was significantly lower than that in patients with normal neural and muscular funtion. Conclusions Patients with end stage kidney disease are more sensitive to cisatraeurium.