CAJ | 학술논문

目的：通过测定顺式阿曲库铵的血药浓度及肌松监测，探讨用血药浓度代表肌松恢复程度的可行性，以期为顺式阿曲库铵的靶控输注提供参考。方法选择30例，ASAⅠ~Ⅱ级拟在全麻下行择期手术的患者。麻醉诱导采用依托咪酯，舒芬太尼，顺式阿曲库铵（0.2 mg/kg）；麻醉维持采用丙泊酚，瑞芬太尼持续输注。分别记录肌松药的起效时间T0（注药毕至T1抑制至0的时间），从4个成串刺激（train of four, TOF）开始恢复至恢复50%、75%、90%及100%的时间TOFr50、TOFr75、TOFr90、TOFr100，并分别于上述时间点采集输液对侧动脉血3 ml，以测定相应时间点顺式阿曲库铵的血药浓度。结果顺式阿曲库铵的起效时间T0为（3.35±1.03）min，TOFr50为（21.03±7.91）min，其血药浓度占初始血药浓度的百分比 R50为（32.15±11.53）%；TOFr75为（30.36±10.70）min，R75为（18.87±7.53）%；TOFr90为（38.80±11.00）min，R90为（14.85±8.70）%；TOFr100为（46.67±13.34）min，R100为（8.30±3.45）%。经Pearson相关性检验，变量TOFr与R呈显著负相关（r=-0.688）。结论血浆药物浓度的衰减与肌松程度的恢复之间具有明显的相关性，用血药浓度代表肌松恢复程度具有一定可行性。
목적：통과측정순식아곡고안적혈약농도급기송감측，탐토용혈약농도대표기송회복정도적가행성，이기위순식아곡고안적파공수주제공삼고。방법선택30례，ASAⅠ~Ⅱ급의재전마하행택기수술적환자。마취유도채용의탁미지，서분태니，순식아곡고안（0.2 mg/kg）；마취유지채용병박분，서분태니지속수주。분별기록기송약적기효시간T0（주약필지T1억제지0적시간），종4개성천자격（train of four, TOF）개시회복지회복50%、75%、90%급100%적시간TOFr50、TOFr75、TOFr90、TOFr100，병분별우상술시간점채집수액대측동맥혈3 ml，이측정상응시간점순식아곡고안적혈약농도。결과순식아곡고안적기효시간T0위（3.35±1.03）min，TOFr50위（21.03±7.91）min，기혈약농도점초시혈약농도적백분비 R50위（32.15±11.53）%；TOFr75위（30.36±10.70）min，R75위（18.87±7.53）%；TOFr90위（38.80±11.00）min，R90위（14.85±8.70）%；TOFr100위（46.67±13.34）min，R100위（8.30±3.45）%。경Pearson상관성검험，변량TOFr여R정현저부상관（r=-0.688）。결론혈장약물농도적쇠감여기송정도적회복지간구유명현적상관성，용혈약농도대표기송회복정도구유일정가행성。
Objective To discuss the feasibility of using plasma cisatracurium concentration as a surrogate marker for the reversal of train of four(TOF) and provide reference for the TCI of cisatracurium. Methods Thirty patients (ASAⅠ~Ⅱ) scheduled for selective surgery under general anesthesia were included in the study. Anesthesia was induced with e-tomidate, sulfentanyl and cisatracurium (0.2 mg/kg). During the surgery, propofol and remifentanyl were continuously in-fused. The following parameters were recorded:the onset time (T0), TOFr50, TOFr75, TOFr90, and TOFr100. At each time point, 3 ml of atrial blood were withdrawn from the contralateral arm to detect the plasma concentration of cisatracurium. Results The onset time (T0) was (3.35±1.03) min; TOFr50 was (21.03±7.91) min and the percentage of cisatracurium at this time (R50) was (32.15±11.53)%;TOFr75 was (30.36±10.70) min and R75 was (18.87±7.53)%;TOFr90 was (38.80± 11.00) min and R90 was (14.85±8.70 )%;TOFr100 was (46.67±13.34) min and R100 was (8.30±3.45)%. The result of Pearson correlation analysis indicated a significant increase in TOFr with the decrease of R(r=-0.688). Conclusion It is feasible to use plasma concentration of cisatracurium as the surrogate marker for the reversal of TOF.