罗库溴铵对皱眉肌和拇内收肌肌松作用时效的比较  

Difference in onset of and recovery from neuromuscular blockade induced by rocuronium between different muscle groups

作　　者：陈武荣[1] 王红薇[1] 童雷[1] 倪强[1] 于成涛[1] 庄心良[2] 

机构地区：[1]上海中医药大学普陀临床医学院麻醉科,上海市200062 [2]上海交通大学附属第一人民医院麻醉科

出　　处：《中华麻醉学杂志》2005年第3期173-175,共3页Chinese Journal of Anesthesiology

摘　　要：目的比较皱眉肌(CS)和拇内收肌(AP)在罗库溴铵肌松作用起效时间和恢复过程中的差异。方法40例择期行胆囊切除术或胃大部切除术的患者,随机分为2组,A组:罗库溴铵用量为0.6mg,/kg,B组罗库溴铵用量为0.9mg/kg,每组20例。行硬膜外麻醉后,A、B组分别静脉注射罗库溴铵0.6、0.9mg/kg。用TOF同步刺激,并记录CS和AP肌松起效时间,观察在80%肌颤搐抑制时的气管插管条件,以及恢复过程中T125%恢复时间及恢复指数(RI)。每组10例患者在AP的T1达80%抑制时行气管插管,另10例在CS的T1达80%抑制试行气管插管,分别评定该时的气管插管条件。结果A组AP和CS的最大T1抑制均为100%,AP、CS的起效时间分别为106±34、(111±36)s,B组AP和CS的起效时间分别为84±28、(74±26)s;与A组比较,B组AP和CS的起效时间均缩短(P<0.05)。两组在CS抑制达80%时指导气管插管的总体优良率(20/20)明显高于AP抑制达80%时指导气管插管的总体优良率(12/20)(P<0.01)。B组T125%恢复时间和RI均均长于A组(P<0.05)。两组AP与CS的T125%恢复时间与RI比较差异无统计学意义(P>0.05)。结论罗库溴铵的肌松作用时效在CS和AP有差异,3倍ED95较2倍ED95罗库溴铵的肌松起效时间缩短。CS肌群的肌松监测有助于改善气管插管的条件。Objective To examine the difference in the onset of and recovery from the neuro-muscular (N-M) blockade induced by rocuronium measured by acceleromyography of corrugator supercilli (CS) muscle and adductor pollicis (AP) muscle and the implication for clinical N-M monitoring. Methods Forty ASA Ⅰ - Ⅲ patients aged 32-65yr undergoing elective cholecystectomy or gastrectomy under combined general-epidural anesthesia (CGEA) were randomized to receive rocuronium 0.6 mg·kg-1 (group A, n = 20) or 0.9 mg·kg-1 (group B, n = 20) to facilitate tracheal intubation. Patients with N-M transmission disease, serious heart and lung disease or hepato-renal dysfunction were excluded. Epidural was performed at T8-9 or T9-10 . The level of epidural block was below T4. N-M blockade was measured by acceleromyography (TOF-WATCH SX Organon Teknika) of AP muscle at the thumb and CS muscle at the superciliary arch simultaneously. General anesthesia was induced with midazolam 0.05 mg · kg-1 , propofol 2 mg · kg-1 , fentanyl 3 μg · kg-1 and rocuronium 0.6 or 0.9 mg · kg-1 . Tracheal intubation was performed at 80 % depression of T1 . The intubation condition (rated as excellent, good, medium, poor). The onset time (time from injection of rocuronium to maximal depression of T1) and the time of return to 25% and 75% of the control height of T1 were recorded and recovery index (RI) was calculated. Results The onset time of N-M block of CS muscle was (111±36)s at 0.6 mg·kg-1 and (74 ± 26)s at 0.9 mg·kg-1 and that of AP muscle was (106 ± 34) s (0.6 mg·kg-1 ) and (84±28) s (0.9 mg·kg-1 ) . The onset time produced by 0.9 mg·kg-1 was significantly shorter than that produced by 0.6 mg·kg-1 . At 0.6 mg·kg-1 80% depression of T1 of AP muscle was equal to 66% (52%-81 % ) depression of T1 of CS muscle and only 2 out of 10 patients showed good intubation condition. At 0.9 mg·kg-1 80% depression of T1 of AP muscle was epual to 89% (76%-93%) depression of T1 of CS muscle and all patients showed good intubation condition. The recovery o

关 键 词：罗库溴铵 作用时效 拇内收肌 皱眉肌 气管插管条件 起效时间 胃大部切除术 恢复时间 恢复过程 胆囊切除术 肌松作用 静脉注射 恢复指数 肌松监测 优良率 CS AP 抑制 麻醉后 硬膜外 B组分 TOF 肌颤搐 统计学 患者 用量 缩短 

分 类 号：R96[医药卫生—药理学]