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| 老年腰椎结核合并骨质疏松患者麻醉诱导应用顺式阿曲库铵的药效学研究 |
| Pharmacodynamic study of cis-atracurium in the induction of anesthesia on elder patients with spinal tuberculosis combined with osteoporosis |
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| DOI：10.3969/j.issn.1006-7108.2015.02.013 |
| 中文关键词: 老年人 腰椎结核 骨质疏松 顺式阿曲库铵 药效学 |
| 英文关键词:Elder patients Lumbar spine tuberculosis Osteoporosis Cis-atracurium Pharmacodynamics |
| 基金项目:全军医学科技“十二五”面上项目(CWS12J084) |
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| 中文摘要: |
| 目的 比较老年腰椎结核合并骨质疏松患者与普通老年腰椎手术患者麻醉诱导时顺式阿曲库铵药效学的差异。方法 选择2012年6月~2013年6月我院骨科老年腰椎结核合并骨质疏松患者（A组）、老年腰椎手术合并骨质疏松的患者（B组），老年腰椎结核手术患者（C组）和腰椎间盘突出手术患者（D组）各20例进行研究。所有患者均于术前30min肌肉注射阿托品0.5mg。4组患者麻醉诱导均采用静脉注射咪达唑仑0.05mg/kg、丙泊酚2mg/kg、芬太尼5μg/kg和注射单次剂量顺式阿曲库0.15mg/ kg，观察记录诱导期间患者血流动力学变化，同时应用肌松监测仪记录各组起效时间、第一次肌颤搐刺激T1恢复到25%、75%、90%的时间及恢复指数。结果 诱导期间A、B、C、D各组之间的血压、心率变化及肌松药的起效时间之间的差异无统计学意义(P >0.05)，A组注射相同剂量的顺式阿曲库铵后神经肌肉阻滞的25%、75%、90%的恢复时间为34.1±9.5min，45.7±5.6 min，51.8±5.1 min；B组注射相同剂量的顺式阿曲库铵后神经肌肉阻滞的25%、75%、90%的恢复时间为32.2±7.4 min，62.4±2.7 min，63.1±6.4 min；C组注射相同剂量的顺式阿曲库铵后神经肌肉阻滞的25%、75%、90%的恢复时间为33.5±5.4 min,43.6±6.1 min, 49.9±6.7 min；D组注射相同剂量的顺式阿曲库铵后神经肌肉阻滞的25%、75%、90%的恢复时间为44.1±7.0 min，58.7±7.6 min，64.9±5.3 min。A组较B、D组的恢复时间显著缩短(P <0.05)。 而A组注射相同剂量的顺式阿曲库铵后神经肌肉阻滞的恢复时间与C组之间差异无统计学意义(P >0.05)。结论 腰椎结核患者麻醉诱导时应用顺式阿曲库铵可显著降低其作用时间，而单纯骨质疏松患者麻醉诱导时不会影响应用顺式阿曲库铵的作用时间。 |
| 英文摘要: |
| Objective To compare the pharmacodynamic change of cis-atracurium use between patients with or without spinal tuberculosis and osteoporosis in the induction of anesthesia. Methods Four groups of elder patients scheduled for spinal surgery in our hospital from August 2012 to June 2013were chosen for this study. Elder patients with lumbar spine tuberculosis and osteoporosis were in Group A (N=20). Elder patients with osteoporosis were in Group B (N=20). Elder patients with lumbar spine tuberculosis were in Group C (N=20). Elder patients with intervertebral disk hernia were in Group D. A single intramuscular injection of atropine 0.5mg was given 30 min before the anesthesia. All patients were induced intravenously with 0.05mg/kg midazolam, 2mg/kg propofol, 5μg/kg fentanyl, and 0.15mg/kg cis-atracurium. The hemodynamic parameters were recorded during the induction. Neuromuscular function monitoring was performed to record the onset time of muscle relaxant, the recovery time of T1 from 0 to 25%, 75%, and 90%, and the recovery index in each group. Results The BP, HR, and onset time of muscle relaxant between the 4 groups were not significantly different during induction (P>0.05). After injection of the same dose of cis-atracurium, the 25%, 75%, 90% recovery time were 34.1±9.5min, 45.7±5.6 min, and 51.8±5.1 min in group A, 32.2±7.4 min, 62.4±2.7 min, and 63.1±6.4 min in group B, 33.5±5.4 min, 43.6±6.1 min, and 49.9±6.7 min in group C, and 44.1±7.0 min, 58.7±7.6 min, and 64.9±5.3 min in group D, respectively. The recovery time in group A was significantly shorter than that in group B and D (P<0.05). There was no difference in the recovery time after single injection of cis-atracurium between group A and C (P>0.05). Conclusion The duration of cis-atracurium during anesthesia was shorter in patients with spinal tuberculosis but not patients with osteoporosis. |
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