摘要
目的探讨罗库溴铵(Rocuronium,ROC)按肥胖患者去脂肪体质量与实际体质量持续静注给药的药效学差异。方法选择择期腹腔镜肠癌手术20例(手术时间> 3 h),ASA分级Ⅰ～Ⅱ级,BMI=30～35 kg/m2,根据给药方式不同,分为两组:按实际体质量给药组(OR组)和按去脂肪体质量给药组(OL组),每组10例。采用TOFWatch SX Monitor型加速度肌松监测仪进行肌松监测,诱导ROC分别按2倍实际体质量或去脂肪体质量的ED95静注给药,当t1开始恢复(即恢复至3%)时,两组分别按上述剂量持续静脉输注ROC,预计手术结束前30 min停止输注。记录起效时间、持续输注时间、麻醉时间、PTC平均值、平均用药量和总用药量,以及临床作用时间、恢复指数及恢复时间。结果组间比较,诱导剂量、输注速率及输注用药总量均无统计学差异。药效学比较,OR组的起效时间明显短于OL组(P <0. 05),且PTC均值、临床作用时间、恢复指数及恢复时间,OR组比OL组显著延长且差异有统计学意义(P <0. 05)。结论肥胖患者长时间手术中按去脂肪体质量持续泵注给药,可减少给药剂量,使恢复时间变短,在无肌松监测仪的情况下减少肌松残余作用的发生,适合广泛应用于临床。
Ojbective To compare the pharmacodynamics of continuous infusion of Rocuronium by lean body mass(LBM)with by real body weight(RBW)in obese patients undergoing long-time surgeries during recovery phase.Methods A total of 20 patients(operation time>3 hours,BMI:30~35kg/m^2,ASA:I-II)scheduled for laparoscopic surgery for bowel cancer under general anesthesia were enrolled in the study.They were equally divided into two groups:the LBM group receiving an intravenous bolus of double ED95 dosage of rocuronium by lean body mass(LBM)and the other as RBM group by real body mass(RBM).When t 1 recovered to 3%,a continuous intravenous infusion of rocuronium with a rate of the number as above and the infusion was stopped 30 min before the end of the operation.The amounts of onset and infusion time,anesthesia duration,PTC value,average dose and total dose of ROC during neuromuscular block maintenance period,and the time from PTC=2 to TOF recovered to 0.9,and the time of t 1 recovered to 25%,and t 1 recovered from 25%to 75%were recorded.Results The induction dose,infusion rate and total infusion dose were no statistically different between them.According to pharmaceutical comparison,the onset time of group LBM was significantly shorter than that of RBM group.PTC value,the time from PTC=2 to TOF recovered to 0.9,the time of t 1 recovered to 25%,and t 1 recovered from 25%to 75%were significantly ly longer than those of RBM group(P<0.05).Conclusion The continuous infusion of rocuronium by the lean body weight for Ooese patients undergoing long-time operation can not only achieve good muscle relaxation effect,but also reduce the dose and the recovery time and the occurrence of muscle relaxants.It is worth popularizing clinically.
作者
张艳静
吴惠言
付晖
邢祖民
ZHANG Yanjing;WU Huiyan;FU Hui;XING Zumin(Shunde Hospital,Southern Medical University,Foshan 528300,China)
出处
《现代医院》
2019年第2期295-297,共3页
Modern Hospitals
基金
佛山市十三五重点专科项目资助(FSZDZK135049)
