摘要
目的 探讨罗库溴铵和阿曲库铵联合应用时的肌松效应。方法择期全麻手术女性成年患者147例，丙泊酚和舒芬太尼静脉诱导，输注丙泊酚维持麻醉。面罩辅助或控制呼吸，用加速度仪以连续4次刺激（TOF）方式透皮刺激腕部尺神经，获取肌松药作用起效时间和T1最大抑制程度（Tmax）。按观测项目将患者均分成四组。结果阿曲溴铵ED95为（220．8±3．6）μg／kg，罗库溴铵ED95为（286．3±3．1）μg／kg。0．5×ED95的罗库溴铵与阿曲库铵联合使用，肌松效应达到T1抑制93％～97％时，阿曲库铵的剂量为63．6μg／kg。罗库溴铵0．5×ED95与阿曲库铵63．6μg／kg联合使用，Tmax为（95．3±0．9）％，变异系数1．0％。Ⅳ组中三个亚组的Tmax基本相同，合用组作用起效时间比阿曲库铵组快（P〈0．01）。给予肌松药前和注药后5min内，MAP和HR的波动幅度均小于5％。结论罗库溴铵与阿曲库铵合用呈协同作用。当罗库溴铵剂量为0．5×ED95时，为获得T1抑制95％的肌松效应，阿曲库铵的合理用量为63．6μg／kg，比阿曲库铵的ED95减少71．2％。
Objective To study the neuromuscular blocking efficacy of atracurium combined with rocuronium. Methods One hundred and forty-seven female ASA class Ⅰ patients,aged 18 to 55 years old,scheduled for selective surgery were enrolled. General anesthesia was induced with propofol and sulfentanil,and maintained by propofol infusion. The patients were divided into atracurium group （group Ⅰ ,n=32）,rocuronium group （group Ⅱ , n= 40） , combination group （group Ⅲ,n=30） and neuromuscular function determine group （group Ⅳ ,n= 45）. Neuromuscular function was assessed by train-of-four（TOF） stimulation and the maximum depression degree of the T1 of the TOF stimulation （Tmax） and onset time were recorded. Results The ED95 of rocuronium and atracurium were （286.3 ± 3. 1） μg/kg and （220.8± 3.6） μg/kg respectively. When combined with 0.5 ）〈 ED95 rocuronium and 93%-97 %depression of T1 achieved,the optimal dose of atracurium was 63.6 μg/kg. The Tmax and coefficient of variation were （95.3 ± 0.9）% and 1.0% respectively. The onset time of the three subgroups of group Ⅳ were （177.0±34.6） s,（281.3±70.4） s and （227.0±41.6） s and were significantly different, but Tmax were similar and the hemodynamic fluctuations were less than 5% 5 min before and after administration of muscle relaxants in equipotent dose （ 1 × ED95 ）. Conclusion There is synergic effects between rocuronium and atracurium. When combined with 0.5 ）〈 ED95 rocuronium and 95% depression of T1 was attained, the optimal dose of atracurium is 63.6 μg/kg. Compared to atracurium administered alone,a 71.2% reduction in ED95 is achieved.
出处
《临床麻醉学杂志》
CAS
CSCD
2008年第5期400-402,共3页
Journal of Clinical Anesthesiology
