CAJ | 학술논문

目的：测定不同性别结核病患者维库溴铵的药效学参数。方法择期行全身麻醉手术80例，结核病（ T组）及非结核病（ N组）患者各40例，两组依性别不同分为结核病男性组、女性组及非结核病男性组、女性组，每组20例。所有患者入室后予静脉注射咪达唑仑0.1 mg／kg、芬太尼4μg／kg，靶控输注丙泊酚1～4μg／mL，意识消失后采用4个成串刺激进行肌松监测，静脉推注维库溴铵0.1 mg／kg，当第1个肌颤搐反应（ T1）下降至最低值并连续重复3次以上时行气管插管，记录各组起效时间、T1最大抑制程度、临床作用时间、恢复指数、药理作用时间及气管插管条件和麻醉诱导前（t0）、给予肌松药后5 min（t1）、15 min（t2）、30 min（t3）、45 min（t4）、1 h（t5）时的平均动脉压和心率。结果 T组患者维库溴铵临床作用时间较N组缩短（P＜0.05），但男女比较差异无统计学意义（P＞0.05），N组女性临床作用时间较男性长（P＜0.05）；各亚组间T1最大抑制、起效时间、恢复指数及药理作用时间比较差异无统计学意义（ P＞0.05）。结论结核病患者围术期使用维库溴铵时可不考虑性别因素对阻滞时效的影响。
목적：측정불동성별결핵병환자유고추안적약효학삼수。방법택기행전신마취수술80례，결핵병（ T조）급비결핵병（ N조）환자각40례，량조의성별불동분위결핵병남성조、녀성조급비결핵병남성조、녀성조，매조20례。소유환자입실후여정맥주사미체서륜0.1 mg／kg、분태니4μg／kg，파공수주병박분1～4μg／mL，의식소실후채용4개성천자격진행기송감측，정맥추주유고추안0.1 mg／kg，당제1개기전휵반응（ T1）하강지최저치병련속중복3차이상시행기관삽관，기록각조기효시간、T1최대억제정도、림상작용시간、회복지수、약리작용시간급기관삽관조건화마취유도전（t0）、급여기송약후5 min（t1）、15 min（t2）、30 min（t3）、45 min（t4）、1 h（t5）시적평균동맥압화심솔。결과 T조환자유고추안림상작용시간교N조축단（P＜0.05），단남녀비교차이무통계학의의（P＞0.05），N조녀성림상작용시간교남성장（P＜0.05）；각아조간T1최대억제、기효시간、회복지수급약리작용시간비교차이무통계학의의（ P＞0.05）。결론결핵병환자위술기사용유고추안시가불고필성별인소대조체시효적영향。
Objective To determine the pharmacodynamic parameters of vecuronium in tuberculosis patients with different genders.Methods Eighty patients ( ASA gradeⅠorⅡ) received selective general anesthesia were enrolled in this study, and divided into tuberculosis group ( Group T) and non-tuberculosis group ( Group N) .They were further di-vided into male groups ( Group TM and NM) and female groups ( Group TF and NF) .Each patient received intravenous injection of midazolam by 0.1 mg/kg, fentanyl by 4 μg/kg, and propofol with target plasma concentration of 1~3 μg/mL.The neuromuscular block efficacy was measured by neuromuscular transmission monitor after patients'consciousness disappeared.With an intravenous vecuronium by 0.1 mg/kg, the responses were defined in terms of the percentages of maximum suppression at the first ( T1 ) of the train-of-four ( TOF) of the adductor pollicis muscle.Endotracheal intu-bation was conducted when T1 fell to its lowest and repeated no less than 3 times.The onset time, the maximum inhibition of T1 , the clinical effect time, the recovery index, the pharmacological effect time and the endotracheal intubation condi-tions were recorded.MAP and HR were measured before anesthesia induction ( t0 ) , and 5 min ( t1 ) , 15 min ( t2 ) , 30 min ( t3 ) , 45 min ( t4 ) , and 1 h ( t5 ) after general anesthesia.Results Compared with Group N, the clinical effect time of vecuronium in Group T was significantly shorter ( P<0.05 ) , but there was no significant difference between genders (P>0.05).However, the clinical effect time of vecuronium in Group NF was longer than Group NM (P<0.05).No statistical difference was found in the maximum inhibition of T1 , the onset time, the recovery index, the pharmacological effect time, the endotracheal intubation conditions or, hemodynamics before or after anesthesia induction among the four groups.Conclusion Anesthesiologists could neglect the consequence of blocking aging of vecuronium in tuberculosis pa-tients with different gender.