血清乙酰胆碱受体抗体阳性和阴性重症肌无力患者罗库溴铵肌松时效的比较

中国临床药理学与治疗学 ›› 2014, Vol. 19 ›› Issue (10): 1153-1157.

血清乙酰胆碱受体抗体阳性和阴性重症肌无力患者罗库溴铵肌松时效的比较

曹迎亚, 鲁卫华, 姜小敢, 鲁美静, 吴敬医, 秦雪梅, 姚卫东

皖南医学院弋矶山医院麻醉与重症医学科,芜湖 241001,安徽

收稿日期:2014-01-27 修回日期:2014-09-03 出版日期:2014-10-26 发布日期:2014-10-29
通讯作者: 鲁卫华，男，硕士，主任医师，副教授，研究方向：围术期脏器功能维护。Tel:13955370637 E-mail:lwh683@126.com
作者简介:曹迎亚，女，在读硕士研究生，主要从事围术期并发症研究。Tel:15055324662 E-mail:caoyingya1990@126.com
基金资助:
安徽省卫生厅医学科研项目（2010C066）

Difference in time-course of relaxant effect of rocuronium in acetylcholine receptors antibody seropositive and seronegative patients with myasthenia gravis

CAO Ying-ya, LU Wei-hua, JIANG Xiao-gan, LU Mei-jing, WU Jing-yi, QIN Xue-mei, YAO Wei-dong

Department of Anesthesiology and Critical Care Medicine, Yijishan Hospital, Wannan Medical College, Wuhu 241001,Anhui, China

Received:2014-01-27 Revised:2014-09-03 Online:2014-10-26 Published:2014-10-29

摘要/Abstract

摘要： 目的探讨罗库溴铵在血清乙酰胆碱受体(AchR)抗体阳性和阴性重症肌无力(MG)患者中的肌松效应。方法选择择期行胸骨正中切口胸腺切除术的20例MG患者,根据术前血液生化检查分为AchR抗体阳性组(P组,n=10)和 AchR抗体阴性组(N组,n=10)。依次静脉注射芬太尼 2 μg/kg,咪唑安定 0.05 mg/kg,丙泊酚 1.5 mg/kg 行麻醉诱导,气管插管,采用四个成串刺激监测拇内收肌肌颤搐,刺激电流 60 mA,间隔 12 s,频率 2 Hz,波宽 0.2 ms,定标后静脉注射罗库溴铵 0.6 mg/kg。分别记录肌松起效时间、T₁25%恢复时间、T₁50%恢复时间和恢复指数。术中使用多功能监测仪进行心率变异性分析。结果两组患者各时点MAP、HR、HRV、LF/HF差异无统计学意义(P>0.05)。与N组比较,P组肌松起效时间的差异无统计学意义(P>0.05),P组T₁25%恢复时间、T₁50%恢复时间及恢复指数延长(P<0.05)。结论罗库溴铵在血清AchR抗体阳性MG患者的维持时间长于血清阴性患者,而起效时间无差异。

关键词: 雄甾烷醇类, 重症肌无力, 乙酰胆碱受体抗体, 神经肌肉阻滞, 心率变异性

Abstract: AIM: To compare the time-course of relaxant effect of rocuronium in Acetylcholine receptors (AchR) antibody seropositive and seronegative patients with myasthenia gravis(MG). METHODS: Twenty ASAⅠorⅡMG patients with both sexes, aged 23-59 years, with body mass index of 18-25 kg/m²,scheduled for elective extended thymectomy,were divided into 2 groups according to AChR antibody test: seropositive group (group P, n=10) and seronegative group (group N, n=10).Aesthesia was induced with iv injection of fentanyl 2 μg/kg,midazolam 0.05 mg/kg, and propofol 1.5 mg/kg.All patients were tracheal intubated and mechanically ventilated. Twitch tension was monitored in the adductor pollicis muscle by train-of-four stimulation of the ulnar nerve(intensity 60 mA,interval 12s,frequency 2 Hz, wave length 0.2 ms). Rocuronium 0.6 mg/kg was injected intravenously after calibration. The onset time of muscle relaxation,and time for T₁ to recover to 25%,time for T₁ to recover to 50% and recovery index were recorded.The heart rate variability (HRV) was analyzed during the surgery.RESULTS: There were no significant changes in MAP, HR, HRV, LF/HF ratio at all time in two groups(P>0.05). Compared with group N, there was no significant change in the onset time of muscle relaxation,and the time for T₁ to recover to 25%,time for T₁ to recover to 50% and recovery index were significantly prolonged in group P(P<0.05).CONCLUSION: The duration of rocuronium-induced neuromuscular block is significantly longer in seropositive patients with MG than seronegative,while the onset time is similar between the two groups.

Key words: androstanols, myasthenia gravis, acetylcholine receptors antibody, neuromuscular blockade, heart rate variability

中图分类号:

R746.1

曹迎亚, 鲁卫华, 姜小敢, 鲁美静, 吴敬医, 秦雪梅, 姚卫东. 血清乙酰胆碱受体抗体阳性和阴性重症肌无力患者罗库溴铵肌松时效的比较[J]. 中国临床药理学与治疗学, 2014, 19(10): 1153-1157.

CAO Ying-ya, LU Wei-hua, JIANG Xiao-gan, LU Mei-jing, WU Jing-yi, QIN Xue-mei, YAO Wei-dong. Difference in time-course of relaxant effect of rocuronium in acetylcholine receptors antibody seropositive and seronegative patients with myasthenia gravis[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2014, 19(10): 1153-1157.

参考文献 18

[1]	Vincent A.Immunology of disorders of neuromuscular transmission[J]. Acta Neurol Scand Suppl, 2006, 183:1-7.
[2]	Lindstrom JM,Seybold ME,Lennon VA,et al.Antibody to acetylcholine receptor in myasthenia gravis: prevalence, clinical correlates, and diagnostic value[J]. Neurology, 1998, 51(4):933-939.
[3]	Feng HY, Wang HY, Liu WB, et al.The high frequency and clinical feature of seronegative myasthenia gravis in Southern China[J].Neurol Sci,2013,34(6):919-924.
[4]	Pasutharnchat N, Wacharapluesadee S,Hemachudha T.Clinical manifestations of acetylcholine receptor antibody positive and negative myasthenia gravis[J].J Med Assoc Thai,2012,95(3):313-319.
[5]	Mossman S, Vincent A, Newsom-Davis J.Myasthenia gravis without acetylcholine-receptor antibody: a distinct disease entity[J]. Lancet, 1986,1:116-119.
[6]	Vincent A, Li Z, Hart A, et al.Seronegative myasthenia gravis. Evidence for plasma factor(s) interfering with acetylcholine receptor function[J]. Ann N Y Acad Sci, 1993, 681:529-538.
[7]	Itoh H, Shibata K, Nitta S.Difference in sensitivity to vecuronium between patients with ocular and generalized myasthenia gravis[J]. Br J Anaesth, 2001, 87(6):885-889.
[8]	Cheng CA, Aun CS, Gin T.Comparison of rocuronium and suxamethonium for rapid tracheal intubation in children[J]. Paediatr Anaesth, 2002, 12(2):140-145.
[9]	Sungur Ulke Z, Yavru A, Camci E,et al.Rocuronium and sugammadex in patients with myasthenia gravis undergoing thymectomy[J].Acta Anaesthesiol Scand, 2013,57(6):745-748.
[10]	刘力,闵苏,魏珂.七氟醚和异氟醚对不同浓度罗库溴铵抑制乙酰胆碱受体内向电流的影响[J]. 中国药理学通报,2011,27(1):113-116.
[11]	秦雪梅,鲁卫华,金孝岠,等.罗库溴铵用于重症肌无力患者胸腺切除术的肌松效应[J].中国临床药理学与治疗学, 2012,17(11): 1263-1270.
[12]	McDonald T, Hoffman WE, Berkowitz R, et al. Heart rate variability and plasma catecholamines in patients during opioid detoxification[J].J Neurosurg Anesthesiol,1999,11(3):195-199.
[13]	Moss J.Muscle relaxants and histamine release[J].Acta Anaesthesiol Scand, 1995,106( Suppl),7-12.
[14]	Kido K, Uchida T, Makita K.A case of prolonged neuromuscular blockade possibly related to a high anti-acetylcholine receptor antibody level[J]. Masui, 2013, 62(4):445-448.
[15]	Nilsson E, Meretoja OA.Vecuronium dose-response and maintenance requirements in patients with myasthenia gravis[J]. Anesthesiology, 1990, 73:28-32.
[16]	Mann R, Blobner M, Jelen-Esselborn S, et al.Preanesthetic train-of-four fade predicts the atracurium requirement of myasthenia gravis patients[J]. Anesthesiology, 2000, 93(2):346-350.
[17]	Huang WX, Huang P, Fredrikson S, et al.Decreased mRNA expression of TNF-alpha and IL-10 in non-stimulated peripheral blood mononuclear cells in myasthenia gravis[J]. Eur J Neurol, 2000, 7(2):195-202.
[18]	Itoh H, Shibata K, Nitta S.Sensitivity to vecuronium in seropositive and seronegative patients with myasthenia gravis[J]. Anesth Analg, 2002, 95(1):109-113.