持续输注国产阿曲库铵的药效学观察  

Clinical observation of continuous infusion of homemade atracuriumin patients receiving total intravenous anesthesia

作　　者：邹伟[1] 王瑞[2] 高春霖[3] 薛玉良[4] 

机构地区：[1]中国石油天然气集团公司中心医院麻醉科,河北065000 [2]中国石油天然气集团公司中心医院药剂科,河北065000 [3]天津医科大学第二医院麻醉科 [4]天津市泰达国际心血管病医院麻醉科

出　　处：《天津医科大学学报》2005年第3期451-453,456,共4页Journal of Tianjin Medical University

摘　　要：目的:探讨全凭静脉麻醉下持续输注国产阿曲库铵(atracurium)的可行性及平均输注速率,检测验证其临床效价,为临床应用提供可信依据。方法:选择择期手术病人80例,采用全凭静脉麻醉,肌松监测下(TOF),国产阿曲库铵0.5mg/kg诱导插管,T1恢复至对照值的25%时,开始持续输注维持肌松,调整持续输注速率以维持T1于对照值的1%～10%,术毕前20min左右停止输注。计算维持T190%～99%抑制所需阿曲库铵的平均输注速率。同时观察诱导剂量国产阿曲库铵的起效时间、临床作用时间,TOF无反应期PTC与T1首次出现时间。输注停止后记录恢复指数、拔管时TR值(T4/T1)、DBS值(D2/D1)及停止输注至拔管时间。结果:国产阿曲库铵平均输注速率(5.1±0.4)μg·kg-1·min-1,(0.20±0.02)mg·m-2·min-1。诱导剂量起效时间为(203±47)s,临床作用时间(41.5±4.5)min;无反应期PTC与T1首次出现时间之间及拔管时TR值与DBS值之间均显著相关(P<0.001);输注停止后恢复指数为(14.9±3.7)min,停药到拔管时间(44.1±6.1)min。结论:在肌松监测的指导下,持续输注国产阿曲库铵不但可以为手术提供稳定的、可控的肌肉松弛,而且输注停止后,神经肌肉传递功能恢复迅速而完全。Objective： To examine the average infusion rate necessary to maintain approximately 90%- 99% T1 suppression of homemade atracurium after a single bolus and followed by continuous infusion under total intravenous anesthesia （TIVA）. Methods： 80 patients undergoing elective surgical procedures were studied. All patients received homemade atracurium 0.5 mg/kg to facilitate intubation. The infusion was started when T1 return to 25%. During surgery, the infusion rate was regulated to maintain about 90% -99 % T1 suppression. The infusion was discontinued approximately 20-min before the termination of operation. To calculate the average infusion rate necessary to maintain approximately 90%-99% T1 suppression. Onset time and duration of action of initial dose were recorded, PTC was used when no response to TOF stimulation.Recovery index and extubation time were observed when infusion was stopped. Double burst stimulation and TR were registered during extubating. Results： The average infusion rate was （5.1± 0.4） μg·kg^-1·min^-1, （0.20±0.02） mg·m^-2·min^-1. Onset time and duration of action of initial dose were （203±47） s and （41.5±4.5）min. A close linear relation was found between T1 and the square root of PTC （r=-0.921, P〈0.001）. After termination of infusion, recovery index was （14.9±3.7）min, and extubation time was （44.1±6.1） min ,the DBS ratio was significantly correlated to the TR ratio （r=0.930, P〈0.001 ）. Conclusion： With proper, optimal and quantitative measurement of neuromuscular transmission, homemade atraeurium has proved eminently suitable for administration by infusion for surgical procedures.

关 键 词：国产阿曲库铵 持续输注 全凭静脉麻醉 药效学 

分 类 号：R971.8[医药卫生—药品] R614.2[医药卫生—药学]