摘要
目的比较阿曲库胺与顺苯磺酸阿曲库胺(Cisa)在老年骨科手术患者全麻诱导期中的药效学,以及对肝肾功能和肝脏氧化应激指标的影响,分析两种药物的应用安全性。方法选择2019年02月至2020年02月入南京中医药大学沭阳附属医院行骨科手术的老年患者共96例,平均年龄(68.9±6.7)岁,随机分为对照组和观察组各48例,对照组采用芬太尼(4μg/kg)+咪达唑仑(0.03mg/kg)+异丙酚(1mg/kg)+阿曲库胺(0.15mg/kg)进行全身麻醉诱导,完成气管插管后七氟烷吸入进行维持麻醉,吸入浓度0.8-1.2最小肺泡有效浓度(MAC),监测脑电双频指数(BIS)维持在40-50,术中阿曲库胺1.0-1.5mg/kg/min靶控输注,必要时追加芬太尼;观察组采用Cisa(0.15mg/kg)替代阿曲库胺进行麻醉诱导,术中Cisa(1.0-1.5mg/kg/min)靶控输注替代阿曲库胺。比较两组患者的麻醉效果(包括阻滞起效时间、阻滞维持时间、临床作用时间T25%、体内作用时间T95%和肌松恢复指数),术前和术后24h肝功能指标(ALT和白蛋白)和肾功能指标(血清肌酐),肝脏氧化应激指标包括活性氧(ROS)、超氧化物歧化酶(SOD)、丙二醛(MDA)和还原型谷胱甘肽(GSH)。结果观察组与对照组比较,阻滞起效时间和肌松恢复指数缩短,阻滞维持时间、T25%和T95%延长(P<0.05)。术后24h两组肝功能和肾功能指标比较差异不明显(P>0.05)。但观察组肝脏氧化应激指标ROS、SOD、MDA和GSH水平明显降低(P<0.05)。结论与阿曲库胺相比,Cisa在老年患者全麻诱导期能够缩短阻滞起效时间和肌松恢复指数,延长药物作用时间,提高药效学,不增加肝肾功能损伤,还可以减轻肝脏氧化应激损伤,有较好的应用安全性。
Objective To compare the pharmacodynamics of atracurine and CIS-atracurium besilate(Cisa)in elderly patients for orthopedic surgery during induction period of general anesthesia,as well as the effects on liver and kidney function and liver oxidative stress index,and analyze the application safety of the two drugs.Methods From February 2019to February 2020,96elderly patients with average age of(68.9±6.7)years for orthopaedic surgery were enrolled and randomly divided into control and observation groups,48cases in each group.Fentanyl(4μg/kg)+midazolam(0.03mg/kg)+propofol(1mg/kg)+atracurium(0.15mg/kg)were used in control group for general anesthesia induction,sevoflurane inhalation for maintenance anesthesia after tracheal intubation,inhalation concentration 0.8-1.2 minimum alveolar concentration(MAC),monitoring bispectral index(BIS)maintained at 40-50,atracurine 1.0-1.5mg/kg/min target controlled infusion during operation,and fentanyl added if necessary;in observation group,Cisa(0.15 mg/kg)was used to replace atracurine for anesthesia induction,and Cisa(1.0-1.5mg/kg/min)target controlled infusion was used to replace atracurine.The anesthesia effect(including onset time,maintenance time,clinical effect time T25%,in vivo effect time T95%and muscle relaxation recovery index)was compared in the two groups,liver function indexes(ALT and albumin),renal function index(serum creatinine)and liver oxidative stress indexes including reactive oxygen species(ROS),superoxide dismutase(SOD),malondialdehyde(MDA)and glutathione(GSH)were compared before and after operation 24hin the two groups.Results Compared with control group,the onset time and recovery index of muscle relaxation in observation group were shortened,maintenance time,T25%and T95%were prolonged(P<0.05).There were no differences of liver and renal function in the two groups 24hours after operation(P>0.05).However,the levels of ROS,SOD,MDA and GSH were decreased significantly in observation group after 24hthan control group(P<0.05).Conclusion Compared with atracurin
作者
王利云
屠佳佳
李明艳
WANG Li-yun;TU Jia-jia;LI Ming-yan(Department of Pharmacy,Shuyang Affiliated Hospital,Nanjing University of Traditional Chinese Medicine,Jiangshu Nanjing 223600,China)
出处
《中国实验诊断学》
2021年第7期949-952,共4页
Chinese Journal of Laboratory Diagnosis
基金
2016年江苏省妇幼健康重点学科项目(2016NJMUI09)。
关键词
老年
诱导麻醉
顺苯磺酸阿曲库胺
药效学
氧化应激
肝脏
Elderly
Induction of anesthesia
CIS-atracurium besilate
Pharmacodynamics
Oxidative stress
Liver
