摘要
目的研究性别对腹部手术病人罗库溴铵肌松作用的影响。方法拟在全麻下行腹部手术病人24例,年龄20-59岁,ASA Ⅰ或Ⅱ级,分为男性组(M组)与女性组(F组),每组12例。静脉注射异丙酚、芬太尼、罗库溴铵0．6 mg·kg-1行麻醉诱导。以4个成串刺激(TOF)监测神经肌肉阻滞深度,T1达最低时行气管插管。异丙酚靶控输注(效应室浓度3-4μg·ml-1)及静脉注射芬太尼维持麻醉。T1恢复至10％开始输注罗库溴铵,初始速率0．7 mg·kg-1·h-1,维持T1在5％-10％,术毕停用罗库溴铵,新斯的明0．05 mg·kg-1拮抗肌松效应,记录罗库溴铵的肌松作用指标。结果与F组比较,M 组身高与体重较高,T1最大抑制程度、罗库溴铵平均用药速率、新斯的明拮抗后T1自10％恢复到50％的时间、T1自25％恢复到75％的时间差异无统计学意义,起效时间延长,最大效应持续时间、T1恢复到10％的时间缩短;M组第1个10 min罗库溴铵用药平均速率大于其它时间段,且大于F组(P< 0．05)。结论单次静脉注射罗库溴铵的肌松作用存在性别差异,女性较男性病人敏感。
Objective To evaluate the gender differences in neuromuscular blockade induced with rocuronium in patients undergoing abdominal surgery. Methods Twenty-four ASA Ⅰ or Ⅱ patients aged 20-59 yrs undergoing abdominal surgery under general anesthesia were enrolled in this study. Their body mass index （BMI） ranged between 18.5-25 kg·m^-2. Patients with neuromuscular disease were excluded and no patient was taking any drug that might influence the effect of muscle relaxant. The patients were divided into male group （ n = 12） and female group （n = 12）. The neuromuscular function was monitored and recorded using accelerography （DK-5210, Biometer, Denmark）. The response of adductor pollicis muscle to train-of-four （TOF） stimulation of ulnar nerve were recorded. Body temperature was maintained at 36.0-36.9℃ and room temperature at 24-26℃ during surgery. The premedication included intramuscular atropine 0.01 mg·kg^-1 and oral diazepam 10 mg. Anesthesia was induced with fentanyl 2-4μg·kg^-1 , propofol 2-3 mg·kg^-1 and rocuronium 0.6 mg·kg^-1 . The patients were intubated and mechanically ventilated （VT = 7-10 ml RR = 12-14 bpm）. PET CO2 was maintained between 35-45 mm Hg. Anesthesia was maintained with propofol by TCI （ effect-site concentration was set at 3-4μg· ml^-1 ） and intermittent i.v. boluses of fentanyl. Rocuronium （1 mg· ml^- 1 ） was infused and T1 was maintained at 5 %- 10 % of the control height. At the end of surgery rocuronium infusion was terminated and neostigmine 0.05 mg· kg^- 1 was given i.v.. Results There were significant differences in body weight and height between male and female groups （P 〈 0.05）. The onset time following intubating doses of rocuronium （0.6 mg·kg^-1 ） was significantly shorter in female group than in male group. The duration of maximal effect and the time needed for T1 to return to 10% of control height were significantly longer in females than in males （ P 〈 0.05）. The amount of rocuronium needed to maintain T1 at 5 %- 10 % of the control height during the 1 st 10 min was significantly larger in males than in females （ P 〈 0.05）. Conclusion Females are more sensitive to rocuronium than males.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2006年第4期296-298,共3页
Chinese Journal of Anesthesiology
