舒更葡糖钠逆转肝功能异常患者罗库溴铵神经肌肉阻滞效果的剂量研究

doi:10.11958/20212847

天津医药 ›› 2022, Vol. 50 ›› Issue (11): 1213-1216.doi: 10.11958/20212847

舒更葡糖钠逆转肝功能异常患者罗库溴铵神经肌肉阻滞效果的剂量研究

樊芳菲(), 邓莉^△()

青海大学附属医院麻醉科（邮编810001）

收稿日期:2021-12-26 修回日期:2022-06-10 出版日期:2022-11-15 发布日期:2022-11-11
通讯作者: 邓莉 E-mail:fanfeifei198501@163.com;541251777@qq.com
作者简介:樊芳菲（1985），女，主治医师，主要从事临床麻醉学方面研究。E-mail：fanfeifei198501@163.com
基金资助:
青海省科技计划项目(2017-ZJ-758)

Dose-response study of sugammadex sodium on reversing neuromuscular block of rocuronium in patients with abnormal liver function

FAN Fangfei(), DENG Li^△()

Department of Anesthesiology, the Affiliated Hospital of Qinghai University, Xining 810001, China

Received:2021-12-26 Revised:2022-06-10 Published:2022-11-15 Online:2022-11-11
Contact: DENG Li E-mail:fanfeifei198501@163.com;541251777@qq.com

樊芳菲, 邓莉. 舒更葡糖钠逆转肝功能异常患者罗库溴铵神经肌肉阻滞效果的剂量研究[J]. 天津医药, 2022, 50(11): 1213-1216.

FAN Fangfei, DENG Li. Dose-response study of sugammadex sodium on reversing neuromuscular block of rocuronium in patients with abnormal liver function[J]. Tianjin Medical Journal, 2022, 50(11): 1213-1216.

摘要/Abstract

摘要：

目的探讨舒更葡糖钠逆转肝功能异常患者罗库溴铵神经肌肉阻滞效果的量效关系。方法选取择期行肝部分切除术的患者80例。依据Child-Pugh分级情况将患者分为试验组（Child-Pugh分级A级）和对照组（肝功能正常），每组40例。于手术结束后强直刺激后单刺激肌颤搐计数（PTC）1~2次时即刻静脉注射舒更葡糖钠。2组患者均使用Dixon序贯法调整舒更葡糖钠用药剂量，首例患者静脉注射初始剂量舒更葡糖钠4 mg/kg，剂量梯度0.5 mg/kg。计算舒更葡糖钠的ED₉₅。结果试验组患者术中罗库溴铵使用剂量明显低于对照组（P<0.05）。试验组和对照组患者的舒更葡糖钠最大使用剂量分别为5.5 mg/kg和4.5 mg/kg。对照组Probit模型公式为Probit（P）=-10.891+3.009×剂量，而试验组为Probit（P）=-8.095+1.864×剂量。舒更葡糖钠逆转对照组患者的罗库溴铵神经肌肉阻滞的ED₉₅为4.167 mg/kg（95%CI：3.824~4.509 mg/kg）；而舒更葡糖钠逆转试验组患者的为ED₉₅为5.224 mg/kg（95%CI：4.577~5.872 mg/kg）。结论与肝功能正常患者相比，肝功能异常患者需要更大剂量的舒更葡糖钠才可逆转罗库溴铵神经肌肉阻滞，其ED₉₅为5.224 mg/kg。

关键词: 肝功能不全, 舒更葡糖钠, 罗库溴铵, 95%有效剂量

Abstract:

Objective To investigate the dose-effect relationship of sugammadex sodium on reversing neuromuscular block of rocuronium in patients with liver dysfunction. Methods Eighty patients who underwent elective partial hepatectomy were selected. According to the Child-Pugh classification, patients were divided into the experimental group (Child-Pugh class A) and the control group (normal liver function), with 40 cases in each group. Sugammadex sodium was intravenously injected immediately after the operation at the time of 1-2 times of single-stimulated muscle twitch count (PTC) after tonic stimulation. Dixon sequential method was used to adjust the dosage of sugammadex sodium in both groups, and the first patient was intravenously injected with the initial dose of sugammadex sodium 4 mg/kg, with a dose gradient of 0.5 mg/kg. The ED₉₅ of sugammadex sodium was calculated. Results The intraoperative dose of rocuronium bromide was significantly lower in the experimental group than that in the control group (P<0.05). The maximum dosage of sugammadex sodium was 5.5 mg/kg in the experimental group, and the maximum dosage of sugammadex was 4.5 mg/kg in the control group. The Probit model formula of the control group was Probit(P)=-10.891+3.009×dose, and the Probit model formula of the experimental group was Probit(P)=-8.095+1.864×dose. The ED₉₅ of sugammadex sodium for reversing rocuronium bromide neuromuscular block was 4.167 mg/kg in patients of the control group (95%CI: 3.824-4.509 mg/kg). The ED₉₅ of sugammadex sodium for reversing neuromuscular blockade in patients of the experimental group was 5.224 mg/kg (95%CI: 4.577-5.872 mg/kg). Conclusion Compared with patients with normal liver function, patients with abnormal liver function require a larger dose of sugammadex to reverse the neuromuscular blockade of rocuronium bromide, with an ED₉₅ of 5.224 mg/kg.

Key words: hepatic insufficiency, sugammadex sodium, rocuronium, 95% effective dose

中图分类号:

R762

图/表 6

表1 2组患者一般资料的比较

Tab.1 Comparison of general information between the two groups of patients

组别	n	年龄（岁）	性别（男/女）	BMI（kg/m²）	手术时间（min）	罗库溴铵（mg）	血肌酐（μmol/L）	尿素氮（mmol/L）
对照组	40	56.8±5.1	28/12	22.7±2.2	98±15	57±25	82.7±9.7	4.8±1.0
试验组	40	57.3±5.5	24/16	22.3±2.5	104±18	47±16	86.4±10.2	5.1±0.9
t或χ²		0.422	0.879	0.760	1.620	2.131^＊	1.662	1.410

图1 舒更葡糖钠逆转罗库溴铵神经阻滞成功率的对比

Fig.1 Comparison of success rate of sugammadex sodium reversing rocuronium nerve block between the different concentrations of sugammadex sodium

图2 试验组患者神经肌肉阻滞恢复情况黑色圆点代表逆转成功；空心圆点代表未逆转成功。

Fig.2 Recovery of neuromuscular block in patients of the treatment group

图3 对照组患者神经肌肉阻滞恢复情况黑色圆点代表逆转成功；空心圆点代表未逆转成功。

Fig.3 Recovery of neuromuscular block in patients of the control group

图4 试验组患者舒更葡糖钠剂量反应图

Fig.4 Dose response relationship diagram of sugammadex sodium in the treatment group

图5 对照组患者舒更葡糖钠剂量反应图

Fig.5 Dose response relationship diagram of sugammadex sodium in the control group

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舒更葡糖钠逆转肝功能异常患者罗库溴铵神经肌肉阻滞效果的剂量研究

Dose-response study of sugammadex sodium on reversing neuromuscular block of rocuronium in patients with abnormal liver function

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