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目的:探讨不同肝功能分级患者对肌松药罗库溴铵药效动力学的影响。方法:纳入肝功能障碍的手术患者152例,根据肝功能Child-Pugh分级将其分为Child-Pugh A级组62例、Child-Pugh B级组55例、Child-Pugh C级组35例,同时纳入肝功能正常患者60例为对照组。以维库溴铵以动态靶控输注程序控制,0.15~0.2μg/m L之间,维持肌松水平T1/TC在25%以内。对比分析四组间一般情况(包括性别、年龄、体重和BMI指数)、麻醉起效时间、最大阻滞持续时间、T110%恢复时间、T125%恢复时间、T175%恢复时间、恢复指数。结果:Child-Pugh A、B、C组患者的麻醉起效时间逐渐延长,组间差异有统计学意义(P<0.05)。Child-Pugh A、B、C三组间患者的麻醉最大阻滞程度逐渐下降,组间差异有统计学意义(P<0.05)。Child-Pugh A、B、C三组间患者的麻醉恢复指数逐渐增大,组间差异有统计学意义(P<0.05)。Child-Pugh A、B、C和对照组间T110%恢复时间、T125%恢复时间、T175%恢复时间无明显差异(P>0.05)。Child-Pugh A级组女性麻醉起效时间明显快于男性,差异有统计学意义(P<0.05);男性最大阻滞持续时间小于女性,性别间差异有统计学意义(P<0.05)。肝功能Child-Pugh B级组女性麻醉起效时间明显快于男性,差异有统计学意义(P<0.05)。肝功能Child-Pugh C级组性别间麻醉起效时间、最大阻滞持续时间、恢复指数差异无统计学意义(P>0.05)。结论:肝功能障碍明显影响肌松药罗库溴铵麻醉起效时间,重度肝功能患者使用罗库溴铵时可不考虑性别的影响因素。
OBJECTIVE: To investigate the pharmacokinetics of muscle relaxant rocuronium in patients with different grades of liver function. Methods: Fifty-two patients with liver dysfunction were divided into Child-Pugh class A group (n = 62), Child-Pugh class B group (n = 55) and Child-Pugh class C group (n = 35) At the same time included 60 patients with normal liver function as control group. With vecuronium bromide controlled by dynamic target-controlled infusion program, 0.15 ~ 0.2μg / m L, maintain the level of muscle relaxation T1 / TC within 25%. The general situation (including gender, age, body weight and BMI index), anesthesia onset time, maximal block duration, T110% recovery time, T125% recovery time, T175% recovery time and recovery index were compared between the four groups. Results: The onset of anesthesia in Child-Pugh A, B and C groups was gradually prolonged, with a significant difference between the two groups (P <0.05). The maximal block of anesthesia in Child-Pugh A, B and C groups decreased gradually, with significant difference between groups (P <0.05). The recovery index of anesthesia in Child-Pugh A, B and C groups increased gradually with statistical significance (P <0.05). Child-Pugh A, B, C and control group T110% recovery time, T125% recovery time, T175% recovery time no significant difference (P> 0.05). Child-Pugh A group of women anesthesia onset time was significantly faster than men, the difference was statistically significant (P <0.05); male duration of maximum block was less than women, gender differences were statistically significant (P <0.05). The onset of anesthesia in Child-Pugh B-class liver function group was significantly faster than that in male group, with significant difference (P <0.05). There were no significant differences in the onset of anesthesia, the duration of maximum block, and the recovery index of Child-Pugh C-level liver function (P> 0.05). Conclusions: Hepatic dysfunction significantly affects the onset time of rocuronium in muscle relaxants. The use of rocuronium in patients with severe liver function may not consider the influence factors of sex.