Lien C A, Matteo R S, Ornstein E, Schwartz A E, Diaz J
Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York.
Anesth Analg. 1991 Jul;73(1):39-42. doi: 10.1213/00000539-199107000-00008.
The effects of age on the pharmacokinetics and pharmacodynamics of vecuronium in eight elderly patients aged 72-86 yr and eight younger adults aged 26-48 yr undergoing elective surgical procedures under nitrous oxide-fentanyl anesthesia were studied. Vecuronium (0.1 mg/kg) was given as an intravenous bolus, and the ulnar nerve was stimulated with a square-wave impulse of 0.2-ms duration. The response to stimulation at a frequency of 0.1 Hz was measured and recorded with a force displacement transducer applied to the thumb. Spontaneous recovery was significantly longer in elderly patients than in younger patients (50% recovery time, 97.1 +/- 29 vs 39.8 +/- 14 min, mean +/- SD; recovery index [25%-75%], 49.4 +/- 11 vs 15.0 +/- 8 min). In addition, in elderly patients elimination half-life of vecuronium was significantly prolonged (125 +/- 55 vs 78 +/- 21 min, P = 0.04) and plasma clearance reduced (2.6 +/- 0.6 vs 5.6 +/- 3.2 mL.kg-1.min-1, P = 0.049). The prolonged duration of action of vecuronium in the elderly surgical patients thus appears to be secondary to altered pharmacokinetics consistent with an age-related decrease in renal and hepatic functions.
研究了年龄对8例72 - 86岁老年患者和8例26 - 48岁年轻成人在氧化亚氮-芬太尼麻醉下接受择期外科手术时维库溴铵药代动力学和药效动力学的影响。静脉推注维库溴铵（0.1mg/kg），并用持续时间为0.2毫秒的方波脉冲刺激尺神经。用施加于拇指的力位移传感器测量并记录0.1Hz频率下的刺激反应。老年患者的自发恢复明显比年轻患者长（恢复50%的时间，97.1±29对39.8±14分钟，均值±标准差；恢复指数[25%-75%]，49.4±11对15.0±8分钟）。此外，老年患者维库溴铵的消除半衰期明显延长（125±55对78±21分钟，P = 0.04），血浆清除率降低（2.6±0.6对5.6±3.2mL·kg-1·min-1，P = 0.049）。因此，维库溴铵在老年外科患者中作用时间延长似乎是由于药代动力学改变，这与年龄相关的肾和肝功能下降一致。
