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目的探讨梗阻性黄疸对罗库溴铵作用时效及药物代谢的影响,指导罗库溴铵在此类患者中合理使用,从而进一步指导肝胆手术麻醉的合理用药。方法选择择期行全身麻醉手术的患者30例,分为梗阻性黄疸组(n=15)、对照组(n=15)。两组麻醉均采用连续硬膜外阻滞复合全身麻醉的方法。药效学研究:采用TOF-Watch SX加速度仪监测神经肌肉传导功能,记录药效学的相关指标,比较两组罗库溴铵药效学的差异。药物代谢研究:分别于单次给予罗库溴铵后30、60、90、120、180min等时点采集血样,后用液相色谱-质谱联用的方法测定罗库溴铵血药浓度。比较、分析两组患者罗库溴铵体内代谢情况。结果术前两组患者在年龄、体质指数、凝血酶原时间等方面差异无统计学意义,而总胆红素、直接胆红素和间接胆红素量差异有统计学意义(P<0.01)。两组患者罗库溴铵的起效时间差异无统计学意义,梗阻性黄疸组T1(4个成串刺激第一次颤搐反应)恢复到对照值(T1值的平台期)10%、25%、50%、75%的时间、TOF比值(TOFR)70%的恢复时间以及恢复指数较对照组均延长(P<0.01)。单次给予罗库溴铵后检测30、60、90、120、180min等时点患者罗库溴铵的血药浓度,发现60、90、120min等时点梗阻性黄疸组罗库溴铵的血药浓度高于对照组(P<0.01或P<0.05)。结论梗阻性黄疸可导致罗库溴铵临床有效作用时间延长和恢复时间延长,罗库溴铵的代谢较正常患者减慢;临床上此类患者使用罗库溴铵时,应该适当延长追加药物的时间,术中、术毕建议使用肌松监测仪指导合理用药及麻醉拔管。
Objective To investigate the effect of obstructive jaundice on the effect of rocuronium and drug metabolism, to guide the rational use of rocuronium in such patients, so as to further guide the rational use of anesthesia in hepatobiliary surgery. Methods Thirty patients scheduled for general anesthesia were randomly divided into obstructive jaundice group (n = 15) and control group (n = 15). Both groups were anesthetized with continuous epidural block combined with general anesthesia. Pharmacodynamic study: The neuromuscular conduction function was monitored by TOF-Watch SX accelerometer and the pharmacokinetic parameters were recorded. The pharmacodynamic differences between two groups were compared. Drug metabolism studies: Blood samples were taken at 30, 60, 90, 120 and 180 minutes after single administration of rocuronium, respectively, and the plasma concentration of rocuronium was determined by liquid chromatography-mass spectrometry. Comparison and analysis of the two groups of patients with rocuronium metabolism in vivo. Results There was no significant difference in age, body mass index and prothrombin time between the two groups before surgery, but the total bilirubin, direct bilirubin and indirect bilirubin had statistical significance (P <0.01) . There was no significant difference in the onset time of rocuronium between the two groups. The obstructive jaundice group T1 (the first twitch response of 4-string stimulation) returned to the control value (plateau of T1 value) 10%, 25 %, 50%, 75% of the time, TOFR 70% recovery time and recovery index were longer than the control group (P <0.01). After a single administration of rocuronium, the blood levels of rocuronium in patients at 30, 60, 90, 120, 180 minutes was measured and the blood levels of rocuronium in the group of obstructive jaundice at 60, 90, 120 minutes was found The drug concentration was higher than that of the control group (P <0.01 or P <0.05). Conclusions Obstructive jaundice can lead to the prolongation of clinical effective duration of rocuronium and the prolongation of recovery time, and the metabolism of rocuronium slows down compared with that of normal patients. In the clinical use of rocuronium, such drugs should be extended appropriately Time, intraoperative, surgery is recommended to use muscle relaxation monitor to guide the rational use of drugs and anesthesia extubation.