顺阿曲库铵的药效学及其对组胺释放的影响  

Pharmacodynamics and histamine-releasing potency of cis-atracurium

作　　者：吴新民[1] 李玲[2] 刘毓和[1] 张兰霞[1] 

机构地区：[1]北京大学第一医院麻醉科,100034 [2]北京积水潭医院麻醉科

出　　处：《中华麻醉学杂志》2010年第3期257-261,共5页Chinese Journal of Anesthesiology

摘　　要：目的比较全麻诱导期间不同保存条件下顺阿曲库铵和阿曲库铵的药效学及其对组胺释放的影响。方法择期全麻手术患者45例，ASAⅠ或Ⅱ级，年龄16—71岁，随机分为3组（n=15）：阿曲库铵冷藏组（ATR冷藏组）、顺阿曲库铵冷藏组（CIS冷藏组）和顺阿曲库铵常温组（CIS常温组）。靶控输注异丙酚血浆靶浓度3μg／ml和瑞芬太尼效应室靶浓度3～5ng/ml行麻醉诱导。ATR冷藏组静脉注射冷藏保存的阿曲库铵0．75mg／kg，CIS冷藏组和CIS常温组分别静脉注射冷藏或室温保存的顺阿曲库铵0．15mg／kg。使用肌松监测仪，采用单次颤搐刺激（频率0．1Hz，刺激持续时间0．2ms），测定刺激前臂尺神经拇内收肌的加速度。记录肌颤搐最大抑制程度、起效时间、作用时间和恢复指数。肌颤搐抑制达最大抑制时行气管插管，机械通气，评价气管插管条件。于麻醉诱导前（T0）、给予静脉全麻药后2min（T1）、给予肌松药后2min（T2）和5min（T3）时，记录MAP和HR，观察皮肤情况，同时采集桡动脉血样2ml，采用酶联免疫吸附法测定血浆组胺浓度。结果CIS冷藏组和ATR冷藏组肌颤搐抑制均可达100％，CIS常温组仅53．33％的患者肌颤搐抑制最大达90％。与ATR冷藏组比较，CIS冷藏组起效时间延长，作用时间缩短（P〈0．05），恢复指数差异无统计学意义（P〉0．05）；与CIS冷藏组比较，CIS常温组起效时间延长，作用时间缩短（P〈0．05），恢复指数差异无统计学意义（P〉0．05）。ATR冷藏组和CIS冷藏组的气管插管条件优于CIS常温组（P〈0．05）。两组间不同时点血浆组胺浓度、MAP和HR比较差异无统计学意义（P〉0．05）；与T0时比较，ATR冷藏组T2,3时血浆组胺浓度升高，T1-3时MAP降低，CIS冷藏组T1-3时MAP降低（P〈0．05）。各组患者皮肤均未发现任何变化。结论与冷藏保存的阿曲库铵相比，冷藏保�Objective To evaluate and compare the histamine-releasing, potencies of cis-atracurium and atracurium during induction of general anesthesia. Methods Forty-five ASA Ⅰ or Ⅱ patients aged 16-71 yr undergoing elective surgery under general anesthesia were randomly divided into 3 groups （ n = 15 each） ： group cis-atracurium （stored at 4-8 ℃ ） （group CIS1 ）; group Ⅱ cis-atracurium （stored at room temperature） （group CIS2 ） and group m atracurium （stored at 4-8 ℃ ） （group ATR）. Anesthesia was induced with TCI of prepofol （Cp 3 μg/ml） and remifentanil （Ce 3-5 ng/ml）. A bolus of cis-atracurium 0.15 mg/kg or atraeurium 0.75 mg/kg was given iv over 5-10 s as soon as the patients lost Neuro-muscular block was monitored with TOF- Watch SX （Organon, the Netherlands）. Single stimulation （0.1 Hz） was applied to the ulna nerve at wrist. The maximal degree of N-M block, onset time, duration of action and recovery index were recorded. The patients were intubated and mechanically ventilated when N-M block reached the maximal degree. The intubation condition was evaluated. MAP and HR were continuously monitored. Changes in skin were scored （0 = no change, Ⅰ =flushed 〉 120 s, Ⅱ = erythema,Ⅲ = urticaria）. Blood samples were obtained before （To, baseline）, at 2 rain after induction of anesthesia with TCI of propofol and remifentanil （T1） and 2 and 5 min after CIS/ATR administration （T2, T3 ） for determination of plasma histamine concentration using enzymatically amplified immunoassay. Results The onset time was significantly longer and the duration of action was significantly shorter in group CIS1 than in group ATR. The maximal degree of N-M block was 100% and the intubation condition was excellent in group CIS1 and ATR. There was no significant difference in the recovery index between group CIS1 and ATR. The onset time was significantly longer and duration of action shorter in group CIS2 than in group CIS1 . There was no significant difference in recovery

关 键 词：阿曲库铵 剂量效应关系 药物 组胺 

分 类 号：R614[医药卫生—麻醉学]