CAJ | 학술논문

目的：测定结核病患者维库溴铵的药效学参数。方法将40例择期行全身麻醉手术的患者按疾病的不同分为结核病（T）组及非结核病（N）组，每组20例。2组均静脉输注咪达唑仑0．1 mg·kg－1、芬太尼4μg·kg－1，靶控输注丙泊酚1～4μg·mL－1，等患者意识消失后采用4个成串刺激（TOF）进行肌松监测，静脉注射维库溴铵0．1 mg·kg－1，注药时间5 s。当第一个肌颤搐反应（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、气管插管条件及麻醉诱导前（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（MAP）和心率（HR）的变化。结果2组麻醉诱导后各时间段的 MAP 及 HR 较 t0均有不同程度下降（均 P ＜0．05）；2组麻醉诱导前及麻醉诱导后各时间点的 MAP 及 HR 比较差异均无统计学意义（均 P ＞0．05）。T 组维库溴铵临床作用时间较 N 组明显缩短（P ＜0．05）；2组 T1最大抑制程度、起效时间、恢复指数及药理作用时间比较差异均无统计学意义（均 P ＞0．05）。肌松监测过程中所有患者均未发生体动，也未见皮疹、低血压、气道峰压升高等不良反应，气管插管均一次成功。结论结核病患者维库溴铵单次静脉注射时 T1最大抑制程度、起效时间、恢复指数及药理作用时间与一般患者相似，但其临床作用时间较短。
목적：측정결핵병환자유고추안적약효학삼수。방법장40례택기행전신마취수술적환자안질병적불동분위결핵병（T）조급비결핵병（N）조，매조20례。2조균정맥수주미체서륜0．1 mg·kg－1、분태니4μg·kg－1，파공수주병박분1～4μg·mL－1，등환자의식소실후채용4개성천자격（TOF）진행기송감측，정맥주사유고추안0．1 mg·kg－1，주약시간5 s。당제일개기전휵반응（T1）하강지최저치병련속중복3차이상시행기관삽관，기록기효시간、T1최대억제정도、림상작용시간、회복지수、약리작용시간、기관삽관조건급마취유도전（t0）、급여기송약후5 min（t1）、15 min（t2）、30 min（t3）、45 min（t4）、1 h（t5）시적평균동맥압（MAP）화심솔（HR）적변화。결과2조마취유도후각시간단적 MAP 급 HR 교 t0균유불동정도하강（균 P ＜0．05）；2조마취유도전급마취유도후각시간점적 MAP 급 HR 비교차이균무통계학의의（균 P ＞0．05）。T 조유고추안림상작용시간교 N 조명현축단（P ＜0．05）；2조 T1최대억제정도、기효시간、회복지수급약리작용시간비교차이균무통계학의의（균 P ＞0．05）。기송감측과정중소유환자균미발생체동，야미견피진、저혈압、기도봉압승고등불량반응，기관삽관균일차성공。결론결핵병환자유고추안단차정맥주사시 T1최대억제정도、기효시간、회복지수급약리작용시간여일반환자상사，단기림상작용시간교단。
ABSTRACT:Objective To determine the pharmacodynamic parameters of vecuronium in patients with tuberculosis.Methods Forty patients undergoing elective operation under general anesthesia were divided into tuberculosis group (group T)and non-tuberculosis group (group N),with 20 patients in each group.All patients received intravenous infusion of 0.1 mg·kg-1 midazolam and 4 μg·kg-1 fentanyl and target-controlled infusion of 1-4 μg·mL-1 propofol.After loss of con-sciousness,neuromuscular monitoring was measured using train-of-four (TOF)stimulation and 0.1 mg·kg-1 vecuronium was intravenously injected with the duration of injection of 5 seconds. Endotracheal intubation was performed when the first twitch response (T1 )fell to the lowest val-ue and repeated 3 times or more.The onset time,maximum inhibition of T1 ,clinical duration of action,recovery index,duration of pharmacological activity and endotracheal intubation conditions were recorded.In addition,mean arterial pressure (MAP)and heart rate (HR)were measured be-fore anesthesia induction (t0 )and 5,15,30,45 and 60 minutes after administration of muscle re-laxant (t1 ,t2 ,t3 ,t4 and t5 ,respectively).Results Compared with t0 ,the MAP and HR significant-ly decreased after anesthesia induction in both groups (P <0.05).However,there were no signifi-cant differences in the MAP and HR among different time points after anesthesia induction (P >0.05).Compared with group N,clinical duration of vecuronium action was significantly shortened in group T (P <0.05).No significant differences in the maximum inhibition of T1 ,onset time,re-covery index and duration of pharmacological activity were found between the two groups (P >0.05).No patients had body movement,rash,hypotension,high airway peak pressure and other adverse reactions during neuromuscular monitoring.Endotracheal intubation was successfully per-formed at the first attempt in all patients.Conclusion Compared with non-tuberculosis patients, the single intravenous injection of vecuronium has no significant effects on the maximum inhibi-tion of T1 ,onset time,recovery index and duration of pharmacological activity,but obviously shortens the duration of pharmacological activity in tuberculosis patients.