CAJ | 학술논문

目的：探讨性别对结核病患者顺式阿曲库铵药效学参数的影响。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40例，两组依性别不同分为结核病男性组（ TM组）、女性组（ TF组）及非结核病男性组（ NM组）、女性组（ NF组），每组20例。所有患者入室后予静脉输注咪达唑仑0．1 mg／kg、芬太尼4μg／kg，靶控输注丙泊酚1～4μg／mL，患者意识消失后采用4个成串刺激进行肌松监测，静脉注射顺式阿曲库铵0．15 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。结果与男性相比，T组女性起效时间较短，临床作用时间及药理作用时间较长（ P＜0．01）；与N组相比，T组患者顺式阿曲库铵临床作用时间及药理作用时间较短，但组间差异无统计学意义（ P＞0．05）。结论结核病患者顺式阿曲库铵单次静脉注射时女性较男性更敏感，表现为起效时间较短，临床作用时间及药理作用时间较长。
목적：탐토성별대결핵병환자순식아곡고안약효학삼수적영향。방법택기행전신마취수술80례，결핵병（ T조）급비결핵병（ N조）환자40례，량조의성별불동분위결핵병남성조（ TM조）、녀성조（ TF조）급비결핵병남성조（ NM조）、녀성조（ NF조），매조20례。소유환자입실후여정맥수주미체서륜0．1 mg／kg、분태니4μg／kg，파공수주병박분1～4μg／mL，환자의식소실후채용4개성천자격진행기송감측，정맥주사순식아곡고안0．15 mg／kg，당제1개기전휵반응（ T1）하강지최저치병련속중복3차이상시행기관삽관，기록기효시간、T1최대억제정도、림상작용시간、회복지수、약리작용시간급기관삽관조건화마취유도전（t0）、급여기송약후5 min（t1）、15 min（t2）、30 min（t3）、45 min（t4）、1 h（t5）시적평균동맥압화심솔。결과여남성상비，T조녀성기효시간교단，림상작용시간급약리작용시간교장（ P＜0．01）；여N조상비，T조환자순식아곡고안림상작용시간급약리작용시간교단，단조간차이무통계학의의（ P＞0．05）。결론결핵병환자순식아곡고안단차정맥주사시녀성교남성경민감，표현위기효시간교단，림상작용시간급약리작용시간교장。
Objective To investigate the pharmacodynamic parameters of cis -atracurium in tuberculosis patients with different gender .Methods Eighty patients ( ASAⅠor Ⅱ) received selective general anesthesia were enrolled in this study.They were divided into tuberculosis group (Group T, n=40) andnon -tuberculosis group (Group N, n=40), whom were subsequently subdivided into male (TM and NM) and female (TF and NF) subgroups.All patients re-ceived an intravenous injection of midazolam (0.1 mg/kg), fentanyl (4μg/kg) and propofol (with target plasma concen-tration of 1-4 μg/mL).The neuromuscular block level was measured by neuromuscular transmission monitor after pa -tients'consciousness disappeared .With an intravenous 0.15 mg/kg of cis -atracurium, the responses were defined in terms of the percentages of maximum suppression at the first contraction ( T1 ) of the train-of-four of the adductor polli-cis muscle.Endotracheal intubation was conducted when T 1 fell to its lowest and repeated no less than 3 times.The onset time, the maximum inhibition of T 1 , the clinical effect time , the recovery index , the pharmacological effect time and the endotracheal intubation conditions 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 The onset time of cis-atracurium in Group TF was significant shorter than that in Group TM , with significantly longer clinical effect time ( P<0.01).However, there was no significant difference between Group NM and NF (P>0.05).Compared with Group N, the clinical effect time and pharmacological effect time in Group T were significantly shorter (P<0.05), while there was no significant difference in the onset time , the maximum inhibition of T 1 , the clinical effect time , the recovery index , or the pharmacological effect time between the two groups (P>0.05).No significant difference was found in the endotrache-al intubation conditions or hemodynamics before or after induction among the four subgroups ( P>0.05 ) .Conclusion Female tuberculosis patients are more sensitive to a single intravenous injection of cis -atracurium, presenting with short-ened onset time , and lengthened clinical effect time and pharmacological effect time .