关键词: 糖尿病, 老年人, 顺式阿曲库铵, 神经肌肉阻滞

Abstract: Objective To analyze the effect of the degree of glycemic control on cisatracurium-induced neuromuscular block in the elderly diabetic patients undergoing general anesthesia during perioperative period. Methods A total of 150 elderly patients with diabetes mellitus receiving operation under general anesthesia in our hospital were enrolled and divided into good-control group(n=88, HbA1c≤6.0%) and poor-control group (n=62, HbA1c＞6.0%) according to the value of glycated hemogloglobin (HbA1c) during perioperative period. Seventy contemporary elderly patients without diabetes mellitus who received the operations under general anesthesia were selected as control group. After induction of intravenous anesthesia, all patients received intravenous cisatracurium 0.15 mg/kg, and the degree of neuromuscular block was monitored. The onset time, clinical action time, maximum inhibition degree of muscle convulsions, clinical recovery time, recovery index and 90% recovery index were compared among the three groups. The correlations of HbA1c with the above indexes were analyzed by Pearson linear correlation analysis. The risk factors of neuromuscular block in the elderly diabetic patients were investigated by multivariate Logistic analysis. Results Compared with the other two groups, the onset time was shorter and the levels of clinical action time, maximum inhibition degree of muscle convulsions, clinical recovery time, recovery index and 90% recovery index in the poor-control group were higher(P<0.05). There were no signifcant differences in the level of HbA1c, onset time and maximum inhibition degree of muscle convulsions between the good-control group and the control group (P>0.05). But the clinical action time, clinical recovery time, recovery index and 90% recovery index of the good-control group were higher than those in the control group (P<0.05). The level of HbA1c was positively correlated with clinical action time, recovery index and 90% recovery index (r=0.825,P=0.025;r=0.725,P=0.047; r=0.802, P=0.030), and negatively correlated with onset time (r=-0.912,P=0.009). Multivariate Logistic analysis showed that HbA1c was an independent risk factor of neuromuscular block in the elderly diabetic patients undergoing general anesthesia (OR=2.895, P=0.024). Conclusions High glycemic level can enhance the cisatracurium-induced neuromuscular block in general anesthesia during perioperative period, and inhibit the recovery of the muscle relaxation.

Key words: diabetes mellitus, aged, cisatracurium, neuromuscular block