不同效应室靶浓度异丙酚对喉显微手术患者围麻醉期米库氯铵药效学及药动学的影响

徐迎阳　高光洁　龙晓宏

[摘要] 目的 比較不同靶浓度异丙酚对喉显微手术患者围麻醉期米库氯铵药效学及药动学的影响。 方法 选择2015年6月～2016年9月解放军第四六三医院ASAⅠ～Ⅱ级择期行喉显微手术患者60例，采用随机数字表法将患者分为Ⅰ、Ⅱ、Ⅲ组，每组各20例，异丙酚效应室靶浓度分别为3.0、4.0、5.0 μg/mL。靶控输注异丙酚60 s后，分别静脉注射芬太尼10 μg/kg、米库氯铵0.2 mg/kg，快速气管内插管，复合盐酸瑞芬太尼0.25 μg/（kg·min）维持麻醉镇痛。采用肌松监测仪连续监测尺神经4个成串刺激反应（TOF），记录肌松时效指标。全程监测血流动力学和脑电双频谱指数（BIS）变化，同时测定米库氯铵药代动力学情况。 结果 血流动力学参数比较，三组差异无统计学意义（P > 0.05）。三组患者米库氯铵起效时间差异无统计学意义（P > 0.05），4个成串刺激（TOF）T1值恢复25%时间、T1值恢复75%时间、T1值恢复90%时间、TOF比值（T4/T1）恢复70%时间，Ⅲ组明显延长，与Ⅰ组比较，差异有统计学意义（P < 0.05）。米库氯铵药代动力学参数变化，除相对生物利用度（F）外，其余指标，Ⅲ组与Ⅰ、Ⅱ组比较，差异均有高度统计学意义（P < 0.01）。 结论 异丙酚效应室靶浓度变化与米库氯铵药代动力学改变有剂量依赖相关性，异丙酚效应室靶浓度为4.0 μg/mL时，对米库氯铵药效学影响较小。

[关键词] 靶控输注；异丙酚；米库氯铵；药代动力学；喉显微手术

[中图分类号] R614.2 [文献标识码] A [文章编号] 1673-7210（2017）07（a）-0065-04

[Abstract] Objective To compare the effect of of different target concentration of Propofol on pharmacodynamics and pharmacokinetics of Mivacurium Chloride during perianesthesia of patients underwent microlaryngoscopic surgery. Methods 60 cases of patients with ASA Ⅰ-Ⅱ underwent selective microlaryngoscopic surgery from June 2015 to September 2016 in 463th Hospital of PLA were selected， and divided into group Ⅰ， Ⅱ， Ⅲ by random number table， each gorup had 20 cases. The target effect-sit concentration of Propofol was 3.0， 4.0， 5.0 μg/mL respectively. After target controlled infusion of Propofol for 60 s， intravenous injection of Fentanyl 10 μg/kg， Mivacurium Chloride 0.2 mg/kg was given， and endotracheal intubation rapidly. Anesthesia was maintained with Remifentanil Hydrochloride 0.25 μg/（kg·min）. Ulnar nerve train of 4 stimulation （TOF） was monitored continuously by using acceleration muscle relaxation monitor. Muscle relaxant indicators were recorded. Hemodynamics and BIS were monitored during the whole anesthesia. The pharmacokinetic effects of Mivacurium were measured. Results Comparison of the hemodynamic parameters in the three groups had no significant differences （P > 0.05）. The onset time of Mivacurium in the three groups had no statistically significant difference （P > 0.05）. 25%， 75%， 90% T1 recovery time of TOF and 70% T4/T1 recovery time in the group Ⅲ were significantly prolonged than those of the group Ⅰ， with statistically significant differences （P < 0.05）. In the pharmacokinetic of Mivacurium， in addition to relative bioavailability （F）， the rest of the indicators， compared with the groupⅠ， Ⅱ and group Ⅲ， the differences were statistically significant （P < 0.01）. Conclusion The target effect-sit Propofol concentration and pharmacokinetics of Mivacurium has a dose-dependent correlation. Mivacurium pharmacodyn-amics is unsignificantly effected by target effect-sit propofol concentration of 4.0 μg/mL.

[Key words] Target controlled infusion； Propofol； Mivacurium Chloride； Pharmacokinetic； Microlaryngoscopic surgery

喉显微手术由于其微创性、精确性，已得到广泛应用。异丙酚是公认的快通道静脉麻醉药，其靶控输注（TCI）以简便的操作、良好的可控性、稳定的血药浓度而著称，为精准麻醉提供了良好的实现手段[1-2]。米库氯铵是一种较新型的短效非去极化肌松药，它的特点是起效快、恢复迅速，能快速提供良好的肌松条件[3]。异丙酚对喉显微手术围术期米库氯铵最适宜的效应室靶浓度尚未见报道，本研究旨在探讨不同靶浓度异丙酚对喉显微手术患者围麻醉期米库氯铵药效学及药动学的影响，以期为临床精准麻醉提供科学依据。