CAJ | 학술논문

目的研究七氟醚对顺式阿曲库铵肌松效应影响的性别差异.方法 30例择期行腹腔镜手术患者,ASA Ⅰ级或Ⅱ级,分为男性组(M组,n=15)和女性组(F组,n=15).所有患者插管后均靶控输注3μg/L瑞芬太尼(血浆靶控浓度)和吸入七氟醚维持麻醉,当呼气末浓度稳定为1.3 MAC后继续维持40min,静脉注射总量为45μg/kg的顺式阿曲库铵,用TOF GUARD(丹麦)加速度仪进行肌松监测.顺式阿曲库铵45μg/kg分为3等份分次静注,记录每次注药(15μg/kg)后的起效时间及最大阻滞效应.在最后一次注药后记录:T1恢复到25%、50%、75%的时间(T125%、T150%、T175%);TOF比值(T4/T1)恢复到70%的时间(TOFR 0.7)以及恢复指数(RI).结果 1.3 MAC七氟醚麻醉下顺式阿曲库铵女性患者ED50和ED95分别为22.2(15.8～27.2)和38.4(32.1～54.4)μg/kg;男性患者分别为25.6(19.7～30.8)和42.8(36.3～58.2)μg/kg,两组差异无统计学意义(P＞0.05);两组之间顺式阿曲库铵恢复至T175%和RI差异无统计学意义(P＞0.05);F组顺式阿曲库铵的起效时间较M组快,恢复至T125%、T150%和TOFR 0.7较M组明显延长(P＜0.05).结论 1.3 MAC七氟醚对顺式阿曲库铵ED5o和ED95的影响无性别差异,但女性患者起效较快,其对顺式阿曲库铵恢复至T125%、T150%及TOFR 0.7所需时间长于男性.
목적 연구칠불미대순식아곡고안기송효응영향적성별차이.방법 30례택기행복강경수술환자,ASA Ⅰ급혹Ⅱ급,분위남성조(M조,n=15)화녀성조(F조,n=15).소유환자삽관후균파공수주3μg/L서분태니(혈장파공농도)화흡입칠불미유지마취,당호기말농도은정위1.3 MAC후계속유지40min,정맥주사총량위45μg/kg적순식아곡고안,용TOF GUARD(단맥)가속도의진행기송감측.순식아곡고안45μg/kg분위3등빈분차정주,기록매차주약(15μg/kg)후적기효시간급최대조체효응.재최후일차주약후기록:T1회복도25%、50%、75%적시간(T125%、T150%、T175%);TOF비치(T4/T1)회복도70%적시간(TOFR 0.7)이급회복지수(RI).결과 1.3 MAC칠불미마취하순식아곡고안녀성환자ED50화ED95분별위22.2(15.8～27.2)화38.4(32.1～54.4)μg/kg;남성환자분별위25.6(19.7～30.8)화42.8(36.3～58.2)μg/kg,량조차이무통계학의의(P＞0.05);량조지간순식아곡고안회복지T175%화RI차이무통계학의의(P＞0.05);F조순식아곡고안적기효시간교M조쾌,회복지T125%、T150%화TOFR 0.7교M조명현연장(P＜0.05).결론 1.3 MAC칠불미대순식아곡고안ED5o화ED95적영향무성별차이,단녀성환자기효교쾌,기대순식아곡고안회복지T125%、T150%급TOFR 0.7소수시간장우남성.
Objective To investigate the difference of neuromuscular blocking effect of cis-atracurium under sevoflurane anesthesia between the genders. Methods 30 ASA Ⅰ or Ⅱ patients aged from 18 to 45 years who scheduled for laparoscopic operation were divided into two groups, male group( M group, n = 15 ) and female group ( F group,n = 15). After induction of Anesthesia all cases were maintained with remifentanyl 3μg/L(TCI) and sevoflurane.After 40 minutes of stable end-tidal anaesthetic concentration, a total dose of cisatracurium 45 μg/kg was divided into 3 equal doses( 15μ g/kg each) ,which was administered accumulatively in each patient. The next dose was given when the effect of the previous dose had reached its peak ( T1 was no longer depressed in the height of 3 successive stimuli).Neuromuscular block was monitored using accelograph(TOF GUARD,Denmark). The onset time and maximum depression of T1 of the initial dose and 2 incremental doses were recorded. The cumulative dose-response curves of the two groups were established. The effective dose to obtain 50% and 95% neuromuscular block( ED5o and ED95 ,respectively) were calculated from individual dose-response curves. After the lastincrement of 15 μg/kg, the time for T1 to return to 25% ,50% ,75% and TOF ratio(T4/T1 )to 70% were recorded. The recovery index( RI)was also calculated.Results The mean ED5o and ED95(95% confidence interval)of cisatracurium of women were 22.2( 15.8 ～27.2)and 38.4 ( 32.1 ～ 54.4) μg/kg during sevoflurane (1.3MAC) anaesthesia, while the data of men were 25.6 ( 19.7 ～30.8) μg/kg and 42.8 ( 36.3 ～ 58.2 ) μg/kg, the difference between groups had no statistical significance ( P ＞0. 05). There was no significant difference in the TOF ratio ( T4/T1 ) to 70% and recovery index between the two groups( P ＞0.05 ). The onset time of F group was shorter than M group. The time for T1 to return to 25% ,50% and TOFR 0.7 was significantly longer in the F group than in the M group (P ＜ 0.05). Conclusion The neuromuscular blocking effect of cis-atracurium under 1.3MAC sevoflurane anesthesia remained no difference between genders. But the onset time of women was much faster. Furthermore the effect on the time for T1 to return to 25% ,50% and TOFR 0.7 were greater than men.