CAJ | 학술논문

目的比较眼肌型和全身型重症肌无力患者罗库溴铵的肌松时效.方法择期行胸骨正中切口胸腺切除术的27例患者,性别不限,年龄12 ～64岁,体重指数17～26 kg/m2,ASA分级Ⅰ或Ⅱ级,根据Osserman分型分为2组:眼肌型组(O组,n=10)和全身型组(G组,n=17).依次静脉注射芬太尼2 μg/kg、咪达唑仑0.05 mg/kg和丙泊酚1.5 mg/kg行麻醉诱导,气管插管,采用四个成串刺激模式,刺激电流60 mA,间隔12 s,频率2 Hz,波宽0.2 ms,监测拇内收肌肌颤搐,定标后静脉注射罗库溴铵0.6 mg/kg.记录麻醉诱导前(基础状态)、气管插管后1、3 min时MAP、HR、心率变异性和低频与高频比值,记录肌松起效时间、T125％恢复时间、T150％恢复时间和恢复指数.结果与基础值比较,2组不同时点MAP、HR、心率变异性和低频与高频比值差异无统计学意义(P＞0.05)；与0组比较,G组肌松起效时间差异无统计学意义(P＞0.05),T125％恢复时间、T150％恢复时间及恢复指数延长(P＜0.05).结论罗库溴铵在全身型MG患者的肌松维持时间长于眼肌型,而起效时间无差异.
목적 비교안기형화전신형중증기무력환자라고추안적기송시효.방법 택기행흉골정중절구흉선절제술적27례환자,성별불한,년령12 ～64세,체중지수17～26 kg/m2,ASA분급Ⅰ혹Ⅱ급,근거Osserman분형분위2조:안기형조(O조,n=10)화전신형조(G조,n=17).의차정맥주사분태니2 μg/kg、미체서륜0.05 mg/kg화병박분1.5 mg/kg행마취유도,기관삽관,채용사개성천자격모식,자격전류60 mA,간격12 s,빈솔2 Hz,파관0.2 ms,감측무내수기기전휵,정표후정맥주사라고추안0.6 mg/kg.기록마취유도전(기출상태)、기관삽관후1、3 min시MAP、HR、심솔변이성화저빈여고빈비치,기록기송기효시간、T125％회복시간、T150％회복시간화회복지수.결과 여기출치비교,2조불동시점MAP、HR、심솔변이성화저빈여고빈비치차이무통계학의의(P＞0.05)；여0조비교,G조기송기효시간차이무통계학의의(P＞0.05),T125％회복시간、T150％회복시간급회복지수연장(P＜0.05).결론 라고추안재전신형MG환자적기송유지시간장우안기형,이기효시간무차이.
Objective To compare the time-course of relaxant effect of rocuronium between patients with ocular and generalized myasthenia gravis (MG).Methods Twenty-seven ASA physical status I or Ⅱ patients with MG of both sexes,aged 12-64 yr,with body mass index of 17-26 kg/m2,scheduled for elective extended thymectomy,were divided into 2 groups according to Osserman stage:ocular group (group O,n =10) and generalized group (group G,n =17).Anesthesia was induced with iv injection of fentanyl 2 μg/kg,midazolam 0.05 mg/kg,and propofol 1.5 mg/kg.All patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of propofol 4-8 mg· kg-1 · h-1 and remifentanil 0.2 μg· kg-1 · min-1.Twitch tension was monitored in the adductor pollicis muscle by train-of-four stimulation of the ulnar nerve (intensity 60 mA,interval 12 s,frequency 2 Hz,wave length 0.2 ms).Rocuronium 0.6 mg/kg was injected intravenously after calibration.Mean arterial pressure (MAP),HR,heart rate variability (HRV) and low frequency and high frequency (LF/HF) ratio was recorded.The onset time of muscle relaxation,time for T1 to recover to 25％,time for T1 to recover to 50％ and recovery index were recorded.Results Compared with the baseline value,there were no significant changes in MAP,HR,HRV,LF/HF ratio at all time points in the two groups (P ＞ 0.05).Compared with group O,there was no significant change in the onset time of muscle relaxation,and the time for T1 to recover to 25％,time for T1 to recover to 50％ and recovery index were significantly prolonged in group G (P ＜ 0.05).Conclusion The duration of rocuronium-induced neuromuscular block is significantly longer in patients with generalized MG than those with ocular MG,while the onset time is comparable between the two groups.