低温体外循环对心血管手术病人罗库溴铵和维库溴铵肌松作用的影响  

The influence of hypothermic cardiopulmonary bypass on neuromuscular blockade by rocuronium or vecuronium in patients undergoing cardiac surgery

作　　者：李海波[1] 王宏亮[1] 刘军[1] 石伟东[1] 王淑云[1] 李文志[1] 

机构地区：[1]哈尔滨医科大学附属第二医院麻醉科,150086

出　　处：《中华麻醉学杂志》2007年第4期297-300,共4页Chinese Journal of Anesthesiology

基　　金：黑龙江省科学技术计划项目（青年基金QC01C10）

摘　　要：目的 采用肌松药自适应控制给药系统使病人的肌松水平稳定在恒定水平,研究低温体外循环（CPB）对心血管手术病人罗库溴铵和维库溴铵肌松作用的影响。方法 择期心血管手术病人20例,ASA分级Ⅱ或Ⅲ级,随机分为2组（n=10）：罗库溴铵组（R组）和维库溴铵组（V组）。用加速度仪监测神经肌肉传导功能,采用四个成串刺激,麻醉诱导时静脉注射依托咪酯0．3 mg/kg、芬太尼2～4μg/kg,并采用自适应控制给药系统给予肌松药负荷剂量：罗库溴铵0．3mg/kg（R组）或维库溴铵0．07mg/kg（V组）,T4消失时进行气管插管,当肌松水平恢复到T1=10%时,控制系统开始控制输注泵持续输注肌松药,2组术中肌松水平维持在T1=10%。间断静脉注射芬太尼和咪达唑仑维持麻醉。分别于CPB开始前T1=10%并且持续5min（T1）、CPB中达到设定的最低温度（T2）、CPB停止后5min （T1）采集动脉血,测定肌松药的血药浓度;记录CPB前（麻醉诱导开始至CPB开始前即刻）、CPB中（CPB开始即刻至CPB停止前即刻）和CPB后（CPB停止后即刻至术毕）肌松药的输注速率,记录达设定点时间（从T1=100%至T1=10%的时间）、达稳态时间（从T1=100%到T1稳定在10%的时间）、鼻咽温及拇内收肌皮温。并对本控制系统的性能进行评价。结果 与T1比较,R组和V组T2、T3时肌松药的血药浓度降低,CPB中及CPB后肌松药的输注速率均低于CPB前（P＜0．01）。两组平均超调和平均标准差均在5%以内,控制给药系统性能指标2组间比较差异无统计学意义（P＞0．05）。结论 心血管手术病人芬太尼复合咪达唑仑麻醉下,低温CPB强化了罗库溴铵、维库溴铵的肌松作用。Objective To investigate the influence of hypothermic cardiopulmonary bypass （CPB） on neuromuscular blockade produced by rocuronium or vecuronium. Methods Twenty ASA Ⅱ or Ⅲpatients aged 18- 64 yr weighing 50-77 kg undergoing cardiac surgery under hypothermic CPB were randomly assigned to one of two groups （ n = 10 each） ： group R and group V. The patients were premedicated with intramuscular morphine 0.15 mg/kg and scopolamine 0.01 mg/kg. ECG, BP, HR, CVP, SpO2, PET CO2 and body temperature were continuously monitored before and during anesthesia. Anesthesia was induced with etomidate 0.3 mg/kg and fentanyl 2-4 μg/kg and maintained with fentanyl and midazolam. Neuromuscular blockade was produced with rocuronium or vecuronium. T1 was maintained at 10% of control height during operation using an automatic closedloop drug delivery system which consisted of （1） a computer program incorporating the pharmacokinetics of vecuronium or rocuronium ; （2） Graseby 3500 infusion pump and （3） accelerometer （ Biometer, Denmark） which measures the force of contraction of adductor pollicis muscle to supra-maximal TOF stimulation of ulnar nerve. The plasma concentrations of rocuronium and vecuronium and the infusion rates were measured and recorded before, during and after CPB. The performance of the automatic drug delivery system was evaluated by 2 indicis-mean offset and mean standard deviation （SD）. Results The plasma concentrations of rocuronium and vecuronium and their infusion rates were significantly decreased during and after CPB as compared with those before CPB. The performance of the automatic drug delivery system was good. The mean offset and mean SD were less than 5 %.Conclusion Hypothermic CPB can potentiate the neuromuscular block produced by vectrronium and rocuronium in patients under general anesthesia.

关 键 词：心肺转流术 低温 人工 雄甾烷醇类 维库溴铵 神经肌肉阻滞 

分 类 号：R686[医药卫生—骨科学]