摘要
目的:观察低温体外循环(CPB)对罗库溴铵持续输注速度的影响。方法:拟在CPB下手术的患者分为冠脉搭桥组13例和瓣膜置换组19例。四次成串刺激(TOF)用于评估神经肌肉阻滞的情况,两组均静脉注射罗库溴铵0.6mg/kg,T1最大程度抑制时进行气管插管,当T1恢复至对照值的10%后,开始持续输注罗库溴铵维持肌松,设定初始速率为5μg/(kg·min),随时调整以维持T1于对照值的1%～10%。分别记录两组罗库溴铵诱导剂量起效时间,CPB前、中、后持续输注总用量和持续输注时间。结果:维持T1于对照值的1%～10%,患者CPB前、中、后罗库溴铵平均输注速度[μg/(kg·min)],冠脉搭桥组为5.91±0.78、1.69±0.48和4.08±0.99,瓣膜置换组为6.76±2.12、2.12±0.62和4.20±0.89。与CPB前比较,两组CPB中、后平均输注速度均降低(P<0.01)。两组诱导剂量罗库溴铵起效时间,与标准值(1.5min)比较,均延长(P<0.01)。结论:CPB低温强化了罗库溴铵的肌松作用,心血管手术CPB低温时甚至CPB后,应减少罗库溴铵的用量,可以达到与CPB前常温时相同的肌松水平。心血管疾病可导致罗库溴铵起效延迟。
Objective： To investigate the influence of mild hypothermic cardiopulmonary bypass （CPB） on the infusion velocity of rocuronium used as a continuous infusion. Methods： Thirty-two patients were divided into two groups as follows, thirteen patients scheduled for elective coronary artery bypass grafting and nineteen patients scheduled for elective cardiac valve replacement with CPB under total intravenous anesthesia. Train-of-four （TOF） was used for evaluating the neuromuscular block. The dose 0.6 mg/kg rocuronium was administered in both groups. Tracheal intubation was performed when T1 was depressed the most. After T1 recovered to 10% of the control value, a rocuronium infusion was started at a rate of 5 μg/（kg·min）, and dosage adjusted to maintain T1 at 1%-10% of the control level. The onset times of rocuronium were recorded in both groups. Mean infusion rates before, during and after CPB in each patient were calculated. Results： One way ANOV analysis showed statistically significant differences in rocuronium infusion rates before, during and after CPB（P 〈 0.01 ）. The T1 level of 1%-10% could be achieved with a mean infusion rates [μg/（kg·min）] of 5.91±0.78,1.69±0.48 and 4.08 ± 0.99 in coronary artery bypass grafting group and 6.76 ± 2.12,2.12 ± 0.62 and 4.20 ± 0.89 in cardiac valve replacement group before, during and after CPB, respectively. The onset times of rocuronium were prolonged in these two groups compared with that of control value （P〈0.01）. Conclusion： Rocuronium infusion rates should be halved during CPB. Even after CPB, requirements of rocuronium should be reduced. The onset time of rocuronium is prolonged in patients with cardiovascular disease.
出处
《天津医药》
CAS
北大核心
2007年第2期99-101,共3页
Tianjin Medical Journal
关键词
雄甾烷醇类
低温
体外循环
滴注
药物
androstanols hypothermia extracorporeal circulation instillation, drug
