CAJ | 학술논문

目的：比较顺苯磺酸阿曲库铵按无脂肪体重与实际体重间断静注给药的临床药效学及个体化差异，提供临床用药参考。方法：选择择期手术全麻患者40例，按给药剂量不同分为无脂肪体重组（FFM组）和实际体重组（RBW组），每组20例。全麻诱导采用静注芬太尼3μg/kg，丙泊酚2 mg/kg， FFM组静注顺苯磺酸阿曲库铵129．6μg/kg（2倍ED95），RBW组100μg/kg（2倍ED95），TOF-Watch SX Monitor加速度肌松监测仪行肌松监测。麻醉维持期间当 T1恢复至5％时 FFM 组静注顺苯磺酸阿曲库铵64．8μg/kg （1倍ED95），RBW组50μg/kg（1倍ED95），预计手术结束前20 min 不再追加顺苯磺酸阿曲库铵，使其自然代谢恢复。结果：两组间肌松药维持用量差异有统计学意义（P＜0．05），FFM组肌松药维持用量显著＜RBW组；两组间无反应期和药理作用时间的变异度差异有统计学意义，FFM 组的无反应期和药理作用时间的变异度更小（P＜0．05）。结论：顺苯磺酸阿曲库铵按无脂肪体重间断静注给药，可获得按实际体重相似的肌松效应，减少肌松阻滞时效的个体差异和肌松药用药量，为临床顺苯磺酸阿曲库铵间断给药提供用药参考。
목적：비교순분광산아곡고안안무지방체중여실제체중간단정주급약적림상약효학급개체화차이，제공림상용약삼고。방법：선택택기수술전마환자40례，안급약제량불동분위무지방체중조（FFM조）화실제체중조（RBW조），매조20례。전마유도채용정주분태니3μg/kg，병박분2 mg/kg， FFM조정주순분광산아곡고안129．6μg/kg（2배ED95），RBW조100μg/kg（2배ED95），TOF-Watch SX Monitor가속도기송감측의행기송감측。마취유지기간당 T1회복지5％시 FFM 조정주순분광산아곡고안64．8μg/kg （1배ED95），RBW조50μg/kg（1배ED95），예계수술결속전20 min 불재추가순분광산아곡고안，사기자연대사회복。결과：량조간기송약유지용량차이유통계학의의（P＜0．05），FFM조기송약유지용량현저＜RBW조；량조간무반응기화약리작용시간적변이도차이유통계학의의，FFM 조적무반응기화약리작용시간적변이도경소（P＜0．05）。결론：순분광산아곡고안안무지방체중간단정주급약，가획득안실제체중상사적기송효응，감소기송조체시효적개체차이화기송약용약량，위림상순분광산아곡고안간단급약제공용약삼고。
Ojective To compara the individual differences and clinical efficacy of cis-atracurium intermittent bolus injected according to fat-free mass and real body weight. Methods Forty patients (ASAI-II) who had no neuromuscular disease and underwent selective abdominal surgery under general anesthesia were randomly divided into group FFM (n=20) and group RBW(n=20) according to the different administration method. The responses of adductor pollicis to train-of-four (TOF) stimulation were monitored. Anesthesia was induced with propofol 2 mg/kg, fentanyl 3 ug/kg, cis-atracurium 129.6μg/kg (group FFM) or 100μg /kg (group RBW),and maintained with propofol and fentanyl given by target-controlled infusion. Intubation was attempted when T1 reached maximal inhibition. When the TOF stimulus T1 recovery to 5%, both group additional cis-atracurium 64.8 μg/kg (group FFM) or 50μg /kg (group RBW). The onset time, nonresponsive time, clinical duration, recovery index, pharmacological duration, cis-atracurium consumption, interval and frequency were recorded. Results No significant differences were found in general, interval, frequency,onset time, clinical duration, nonresponsive time,recovery index, pharmacological duration between the two groups (P > 0.05); There were significant differences in the cisatracurium consumption between two groups (P < 0.05); Compare with the group RBW, the differences of pharmacological duration and nonresponsive time between different individuals in group FFM were smaller (P < 0.05). Conclusion It can reduce the individual differences of muscle relaxant effect to apply cis-atracurium and cis-atracurium consumption according to fat-free mass.