顺式阿曲库铵、维库溴铵在妇科腹腔镜手术中的应用比较  

Comparison of cisatracurium and vecuronium in patients undergoing laparoscopic gynecologic surgery

作　　者：刘朝文[1] 刘春[1] 赵娜[1] 邓莉[1] 李有长[1] 

机构地区：[1]重庆市妇幼保健院麻醉科,400013

出　　处：《重庆医学》2009年第24期3067-3069,共3页Chongqing medicine

摘　　要：目的观察单次静脉注射国产顺式阿曲库铵、维库溴铵在短小妇科腹腔镜手术中药效学的差异。方法ASAⅠ～Ⅱ级择期短小（手术时间小于60min）妇科腹腔镜手术患者60例，随机分成顺式阿曲库铵组（A组，n=30）和维库溴铵组（V组，n=30）。采用TOF-Guard加速度仪对尺神经行连续4个成串刺激（TOF）监测拇内收肌肌颤搐反应；气管内插管全凭静脉麻醉，静脉注射咪达唑仑0．03mg／kg，芬太尼3．0μg／kg，异丙酚2．5mg／kg，以及A、V组分别静脉注射0．1mg／kg（2倍ED95）国产顺式阿曲库铵和维库溴铵进行麻醉诱导，靶控输注（TCI）异丙酚3．O～3．5μg／mL和瑞芬太尼4．0～5．0ng／mL维持麻醉；评价气管插管条件，监测麻醉诱导期间血液动力学，记录手术时间，起效时间（肌松药注毕至T。达最大抑制的时间），无反应期（T1消失到T1再出现的时间），T1从最大抑制程度恢复至25％、75％、95％的时间，恢复指数（T1恢复从25％至75％的时间），TOF比值（T4／T1）（TOFR）恢复至70％的时间，以及残余肌松枯抗情况；观察不良反应。结果A、V组手术时间、气管插管条件评级、血液动力学变化差异无统计学意义（P〉0．05）。与A组相比，V组起效时间较短，无反应期长，T1从最大抑制程度恢复至25％、75％、95％的时间较长，以及残余肌松需拮抗的比例较高，差异有统计学意义（P〈0．05）；两组间恢复指数、TOF比值（T4／T1）（TOFR）差异无统计学意义（P〉0．05）。A、V组均无不良反应发生。结论单次静脉注射顺式阿曲库铵与维库溴铵用于短小妇科腹腔镜手术，前者临床肌松作用更短，术毕患者苏醒快、拔管旱，更有利于手术麻醉转台。Objective To evaluate and compare the pharmacodynamics differences after single dose of intravenous cisatracurium and vecuronium in the patients undergoing laparoscopic gynecologic surgery. Methods 60 patients of ASA class I or lI,undergoing laparoscopy surgery were recruited into this study. They were randomly divided into cisatracurium group（group A,n=30） and vecuronium group （group V,n=30）. The TOF-Guard neuromuscular monitor was used to record the response of the adductor pollicis muscle to train-of-four （TOF） stimulations of the ulnar nerve at wrist. Total intravenous anesthesia was induced with midazolam 0. 03 mg/kg,fentanyl 3.0 μg/kg and propofol 2.5 mg/kg in both groups. The muscle relaxants was infused at 0.1 mg/kg （2ED95） cisatracurium in group A and 0. 1 mg/kg （2ED95） vecuronium in group V saperately before intubation. Anesthesia was maintained with target controlled infuslon（TCI）of propofol at an average effect site concentration of 3.0 3. 5μg/mL and remifentanil 4.0-5. 0ng/mL. Recorded the duration of surgery, tracheal intubating conditions and hemodynamic changes, onset time, nonresponse time, recovery time of T1 to 25 %, 75 %, 95 %, recovery index, TOFR and side effects. Results There were no significant differences in duration of surgery, tracheal intubating conditions and hemodynamic changes between two groups （P〉0.05）. Following 0. 1 mg/kg cisatracurium,the onset time was significantly longer compared with groupV（P〈0.05）. In group A recovery of T1 to 25 %,75 %, 95% of control occurred sooner and higher incidence of antagonizing muscle relaxants than group V （P〈 0.05）. There were no significant differences of recovery index and TOFR between the two groups（P〉0.05）. Two groups had no side effects. Conclusion The recovery from single dose of intravenous cisatraeurium was more rapidly in laparoscopic gynecologic surgery compared with vecuronium.

关 键 词：顺式阿曲库铵 维库溴铵 全凭静脉麻醉 妇科 腹腔镜手术 

分 类 号：R614[医药卫生—麻醉学]