七氟醚对于老年人顺阿曲库铵肌松效应的影响.docVIP

七氟醚对于老年人顺阿曲库铵肌松效应的影响 胡潇 闻大翔 杭燕南 【摘要】 目的 比较七氟醚和丙泊酚对于老年人和青壮年人顺阿曲库铵肌松效应的影响。方法 40例行择期手术的病人，ASAI-II级，按年龄分为老年组(≥65岁)和青壮年组(65岁)。每组再随机分为七氟醚组和丙泊酚组,共四组。麻醉诱导使用咪唑安定、异丙酚、芬太尼，利多卡因喷雾剂，插管后七氟醚组吸入1.73%七氟醚,丙泊酚组使用4-6mg/kg/h丙泊酚静脉维持，30分钟后，静脉注射总量为50ug/kg的顺阿曲库铵，用TOF WATCH加速度仪进行肌松监测,首次静注20ug/kg的顺式阿曲库铵，剩余剂量分为3等份分次注射，记录每次注药后起效时间以及最大阻滞效应，用累计剂量法建立四组患者的剂量反应曲线，在最后一次注药后记录：T1恢复到25%、75%、90%的时间(T125%,T175%,T190%)；TOF比值恢复到70%的时间(TOFR 0.7)及恢复指数RI。结果：老年七氟醚、老年丙泊酚、青壮年七氟醚、青壮年丙泊酚ED50，ED95分别为28.51ug/kg，50.93 ug/kg和33.47ug/kg, 59.86ug/kg和26.16ug/kg,48.69ug/kg和31.77ug/kg,55.43ug/kg。七氟醚组顺阿曲库铵的ED50和ED95值显著小于相同年龄段的丙泊酚组(P0.05),但相同麻醉情况下，老年组和青壮年组无显著性差异（P0.05)。四组顺阿曲库铵起效时间无显著性差异（P0.05)。恢复指数吸入组长于同年龄段的非吸入组，老年组长于同等麻醉条件下的非老年组(p0.05)。T125%、 T175%、T190%、TOF70%时间四组间有显著性差异，老年吸入组显著长于其余三组(p0.05),青壮年吸入组显著长于非老年丙泊酚组(p0.05)。结论：相对于TIVA， 1.73%七氟醚吸入麻醉显著减少顺阿曲库铵的ED50和ED95，并延长顺阿曲库铵的肌松维持时间，但不能缩短肌松起效时间；老年人的顺阿曲库铵肌松维持时间要显著长于青壮年人，但起效时间与青壮年人无显著性差异。老年人和青壮年人对顺阿曲库铵量效关系的影响也相似。 【关键词】 顺式阿曲库铵 七氟醚 剂量一效应曲线 ED50 ED95 The effect of sevoflurane on neuromuscular blocking effect of cisatracurium in elderly HU XIAO, WEN Da-xiang, HANG Yan-nan. Department of Anesthesiology, Renji Hospital, Medicine College of Shanghai Jiaotong University, Shanghai 200127, China 【Abstract】Objective This study was designed to compare the effect of sevoflurane and propofol on neuromuscular blocking effect of cisatracurium in elderly and adult. Methods 40 patients, ASA I-II, undergoing elective surgery, were randomly divided into elderly and adult groups, and further divided into two subgroups (Sevoflurane and Propofol). Anaesthesia was induced with midazolam, propofol, fentanyl .After induction, sevoflurane groups were maintained with 1.73% sevoflurane, while TIVA groups were with 4-6mg/kg/h propofol.After 30 minutes cisatracurium was administered increments of 50μg/kg .Cumulative dose-effect curves for cisatracurium were determined during anaesthesia with 1.73% sevoflurane or TIVA. Neuromuscular block was assessed by acceleromyography(TOF-Watch?) after train-of-four(TO