CAJ | 학술논문

目的比较七氟烷对糖尿病和非糖尿病患者罗库溴铵肌松效应的影响.方法择期腹部手术患者60例,年龄45～64岁,ASAⅡ级,其中Ⅱ型糖尿病患者30例,随机分为2组(n=15):异丙酚组(PD组)和七氟烷组(SD组);非糖尿病患者30例,随机分为2组(n=15):异丙酚组(PN组)和七氟烷组(SN组).静脉注射咪达唑仑、异丙酚和芬太尼行麻醉诱导后启动肌松监测,PD组和PN组静脉注射罗库溴铵0.6 mg/kg后气管插管,静脉输注异丙酚维持麻醉;SD组和SN组1%地卡因充分表面麻醉后气管插管.吸入七氟烷(呼气末浓度1.71%)10 min后静脉注射罗库溴铵0.6 mg/kg,吸入七氟烷(呼气末浓度1.71%)维持麻醉.记录肌松起效时间、维持时间和恢复指数.于静脉注射罗库溴铵后10、20、30、40、50、60、70、80、90、100、110、120 min时记录T1/T0比值及TOF比值(T4T1比值).结果 PN组与PD组、SN组与SD组、PD组与SD组间罗库溴铵起效时间、维持时间比较差异无统计学意义(P>0.05).与SN组和PD组比较,SD组恢复指数延长(P<0.05).静脉注射罗库溴铵后60～120 min,SD组T1/T0比值和TOF比值较PD组降低(P<0.05);静脉注射罗库溴铵后80～120 min,SD组TOF比值较SN组降低(P<0.05).结论与非糖尿病患者相比,七氟烷对糖尿病患者罗库溴铵肌松效应的强化作用进一步增强.
목적 비교칠불완대당뇨병화비당뇨병환자라고추안기송효응적영향.방법 택기복부수술환자60례,년령45～64세,ASAⅡ급,기중Ⅱ형당뇨병환자30례,수궤분위2조(n=15):이병분조(PD조)화칠불완조(SD조);비당뇨병환자30례,수궤분위2조(n=15):이병분조(PN조)화칠불완조(SN조).정맥주사미체서륜、이병분화분태니행마취유도후계동기송감측,PD조화PN조정맥주사라고추안0.6 mg/kg후기관삽관,정맥수주이병분유지마취;SD조화SN조1%지잡인충분표면마취후기관삽관.흡입칠불완(호기말농도1.71%)10 min후정맥주사라고추안0.6 mg/kg,흡입칠불완(호기말농도1.71%)유지마취.기록기송기효시간、유지시간화회복지수.우정맥주사라고추안후10、20、30、40、50、60、70、80、90、100、110、120 min시기록T1/T0비치급TOF비치(T4T1비치).결과 PN조여PD조、SN조여SD조、PD조여SD조간라고추안기효시간、유지시간비교차이무통계학의의(P>0.05).여SN조화PD조비교,SD조회복지수연장(P<0.05).정맥주사라고추안후60～120 min,SD조T1/T0비치화TOF비치교PD조강저(P<0.05);정맥주사라고추안후80～120 min,SD조TOF비치교SN조강저(P<0.05).결론 여비당뇨병환자상비,칠불완대당뇨병환자라고추안기송효응적강화작용진일보증강.
Objective To compare the effects of sevofturane on neuromuscular block induced by rocuronium in the patients with or without diabetes mellitus. Methods Thirty diabetic and 30 non-diabetic ASA Ⅱ patients aged 45-64 yr scheduled for elective middle or lower abdominal surgery were studied. Both diabetic and non-diabetic patients were randomly assigned to one of 2 groups (n = 15 each): propofol group (group P) and sevoflurane group (group S). All patients were anesthetized with midazolam, propofol and fentanyl. After loss of consciousness tracheal intubation was performed after rocuronium 0.6 mg/kg and anesthesia was maintained with iv propofol infusion in group P. In group S tracheal intubation was performed under topical anesthesia with 1% amethacaine injected through cricotbyroid membrane. Anesthesia was maintained with sevoflurane inhalation (end-tidal concentration 1.71 %). Rocuronium 0.6 mg/kg was given iv at 10 min after inhalation of sevoflurane was started. Neuromuscular function was assessed by accelerograpby (TOF-Watch SX, Orgnnon, Holland). TOF stimulation of ulnar nerve was used. The onset time, duration of action and recovery index (for T1 to return from 25% to 75% of the control twitch) were recorded. The T1/T0 and TOF (T4/T1) ratios were recorded at 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 110 and 120 min after a single bolus of rocuronium. Results There was no significant difference in onset time and duration of action between diabetic and non-diabetic patients in both propofol and sevoflurane groups. The recovery index was significantly higher in diabetic patients than in non-diabetic patients in group S. The recovery index was significantly higher in group S than in group P in diabetic patients. The ratios of T1/T0 and TOF were significantly lower in group S than in group P in diabetic patients during 60-120 min after a single bolus of rocuronium. The TOF ratio was significantly lower in diabetic patients than in non-diabetic patients in group S during 80-120 min after a single bolus of rocuronium. Conclusion The effect of sevoflurane on rocuronium-induced neuromuscular block is enhanced in diabetic patients compared with non-diabetic patients.