摘要
目的观察新斯的明拮抗维库溴铵的肌松残余作用的剂量反应和安全性。方法全麻下50例患者以咪唑安定、丙泊酚和芬太尼麻醉诱导,七氟醚-N2O、丙泊酚维持麻醉。维库溴铵首剂0.1 mg/kg,术中必要时追加0.05 mg/kg。采用加速度肌松监测仪监测4个成串刺激的比值(TOFR)。术后TOFR恢复至0.55时,患者随机分为N10、N20、N30、N50和对照组(n=10),N10、N20、N30和N50组分别给予新斯的明10、20、30、50μg/kg和阿托品5、10、15、25μg/kg,对照组静脉注射生理盐水2 mL。监测TOFR恢复至0.7、0.9、1.0的时间、心率和血压的变化,观察术后6 h内和24 h内恶心呕吐的发生状况。结果新斯的明明显加快TOFR的恢复(P<0.01),其中N30组和N50组较N10组和N20组恢复时间明显缩短(P<0.05或P<0.01)。N30组和N50组给药后1 min时心率明显增快(P<0.05),各组血压无明显变化(P>0.05)。术后6 h及24 h各组恶心呕吐情况差异无统计学意义(P>0.05)。结论当TOFR值已恢复至0.55时,仍应进行肌松作用的拮抗,不同剂量的新斯的明都能有效地拮抗麻醉恢复期维库溴铵的肌松残余作用,推荐使用小剂量(10～20μg/kg)的新斯的明进行拮抗。
Objective To evaluate the antagonistic dose-effect and safety of neostigmine on vecuronium-induced residual neuromuscular blockade. Methods Fifty patients were induced with midazolam, fentanyl and propofol during general anesthesia, and were maintained with sevoflurane-N2O and propofol. The first dose of vecuronium was 0.1 mg/kg, and bolus doses of 0.05 mg/kg vecuronium were injected as clinically required during surgery. The train-of-four ratio （TOFR） was monitored by acceleromyography. When TOFR recovered to 0.55, patients were randomly assigned to N10 group , N20 group, N30 group, N50 group and control group （ n = 10）. Patients in N10, N20, N30 and N50 group were administrated neostigmine （10, 20, 30, 50 ug/kg） and atropine （5, 10, 15, 25ug/kg） , respectively, and those in control group were intravenously injected with 2 mL normal saline. The time of TOFR recovery to 0.7, 0.9 and 1.0 was monitored, heart rate and blood pressure were recorded, and postoperative nausea and vomiting in 6 h and 24 h were also observed. Results Neostigmine significantly accelerated the recovery of TOFR（P 〈0.01 ）. The time of recovery in N30 group and Nso group was significantly less than that in N10 group and N20 group （ P 〈 0.05 or P 〈 0.01 ）. The heart rates in N30 group and N50 group were significantly increased one minute after administration （P 〈 0.05） , while there was no significant difference in blood pressure among each group （P 〉 0.05 ）. There was no significant difference in the incidence of postoperative nausea and vomiting in 6 h and 24 h among each group （ P 〉 0.05 ）. Conclusion When TOFR recovers to 0.55, antagonism of residual neuromuscular blockade is still necessary. Different doses of neostigmine may antagonize vecuronium-induced residual neuromuscular blockade, and lower dose of neostigmine （10-20 ug/kg） is recommended.
出处
《上海交通大学学报（医学版）》
CAS
CSCD
北大核心
2009年第2期209-212,共4页
Journal of Shanghai Jiao tong University:Medical Science
关键词
肌松残余作用
新斯的明
维库溴铵
拮抗
麻醉
residual neuromuscular blockade
neostigmine
vecuronium
antagonism
anesthesia
