【摘要】 目的:不同病程阶段脓毒症患者顺阿曲库铵的分布消除与术后残余肌松发生的相关性。方法:随机纳入18~65岁拟行腹部手术的患者,根据脓毒症程度分为对照组(n=15)、SIRS组(n=12)和重症脓毒症组(n=9)。术中持续泵注顺阿曲库铵1.6μg/(kg·min),通过质谱法检测其血药浓度。指标包括血浆清除速率(CL),稳态分布容积(Vd,ss),血药浓度-时间曲线,以4个成串刺激率(TOF ratio)<0.9为判断术后残余肌松发生标准。结果:对照组、SIRS组及重症脓毒症组顺阿曲库铵CL分别为(6.6±0.8)mL/(min·kg)、(5.5±1.1)mL/(min·kg)、(4.2±0.6)mL/(min·kg),差异有统计学意义(P<0.05)。各组顺阿曲库铵Vd,ss分别为(206±23)mL/kg、(121±32)mL/kg、(101±61)mL/kg。对照组与其余两组比较差异有统计学意义(P<0.05)。SIRS组与重症脓毒症组比较无统计学意义(P>0.05)。各组术后残余肌松发生率分别为13.3%、16.7%和66.7%,重症脓毒症患者术后残余肌松发生率明显增高(P<0.05)。结论:脓毒症降低顺阿曲库铵在体内的分布和消除,与术后残余肌松发生率缺乏相关性。更多还原

【Abstract】 Objective To evaluate the correlation on distribution and elimination of cis-atracurium in septic patients at different stages with incidence of postoperative residual neuromuscular blockade. Methods Patients planned to receive abdorminal operations aged from 18 to 65 years old were randomly divided into three groups : control group(n = 15); SIRS group(n = 12); severe sepsis group(n = 9). The cisatracurium of 1.6 μg /(kg·min) were given constantly by pump during operations. The blood concentrations were detected by mass spectroscopy. Pharmacodynamic indicators included plasma clearance rate(CL), the apparent volume of distribution(Vcl,ss), blood drug concentration-time curve, Four clusters stimulation ratio(TOF ratio) were applied to evaluate the efficacy of residual muscle relaxant after surgery. Results CL of cisatracurium in control group, SIRS group and severe sepsis group was 6.6 ± 0.8; 5.5 ± 1.1 and 4.2 ± 0.6 mL /(min·kg) respectively. The CL in each group was statistically different(P < 0.05). Vcl, ss of cisatracurium in control group, SIRS group and severe sepsis group was 206 ± 23; 121 ± 32; 101 ± 61 mL / kg respectively. Vcl, ss in control group was statistically different compared with the other 2 groups(P < 0.05). There was no significantly difference between SIRS group and severe sepsis group(P < 0.05). The incidence of residual neuromuscular blockade in control group, SIRS group and severe sepsis group was 13.3%, 16.7% and 66.7% respectively. The incidence of residual neuromuscular blockade in severe sepsis group significantly increased, compared with the other two groups(P < 0.05). Conclusion Sepsis can reduce the distribution and elimination of cisatracurium in vivo, but it is not correlated with the incidence of postoperative residual neuromuscular blockade更多还原