罗库溴铵对风湿性心脏病患者心肌供氧和耗氧量的影响  

Effects of Rocuronium on Myocardial Oxygen Supply-Demand in Patients with Rheumatic Heart Disease during Induction of Anaesthesia

作　　者：陈果[1] 李羽[1] 李茜[1] 吕沛林[1] 周荣华[1] 刘斌[1] 

机构地区：[1]四川大学华西医院麻醉科,四川成都610041

出　　处：《华西医学》2009年第10期2593-2596,共4页West China Medical Journal

摘　　要：目的:在风湿性心脏病患者瓣膜置换术中,评价罗库溴铵在麻醉诱导期间对患者心肌氧供和氧耗平衡的影响。方法:选择86例在中低温体循环下行瓣膜置换术的患者,采用随机双盲法分配成罗库溴铵组(n=42例)和维库溴铵组(n=41例)。给予咪唑安定(0.05～0.1mg/kg)及芬太尼(10～15μg/kg)及等效剂量的罗库溴铵0.6mg/kg或维库溴铵0.1mg/kg(Org.Comp)进行麻醉诱导。监测麻醉诱导前至插管后10分钟(1次/1分)期间两组患者心肌氧供和氧耗的变化。结果:与基础值相比,罗库溴铵组患者在插管后5分钟期间心率增加了17.4%～13.5%,动脉收缩压增加了16.94%～14.3%,平均动脉压增加了15.1%～13.2%。同期心率收缩压乘积增加了22.67%～13.96%(P<0.05)。心率和动脉血压在插管后1～7分钟期间明显高于同期的维库溴铵组患者(P<0.05)。结论:在ASAⅢ-Ⅳ级、心功Ⅱ-Ⅲ级风心病瓣膜病变患者进行瓣膜置换术中,0.6mg/kg罗库溴铵有潜在增加患者心肌耗氧量的作用。Objective：To evaluate the effects of rocuronium on myocardial oxygen supply-demand in patients with rheumatic heart disease （RHD） during induction.Methods：86 patients of either sex （ASA status Ⅲ-Ⅳ;New York Heart Association classes Ⅱ-Ⅲ） scheduled for valve replacement surgery were included in this randomized clinical trial （RCT）.Swan-Ganz catheter was placed via right internal jugular vein before the induction of anaesthesia.Anaesthesia was induced with midazolam 0.05-0.1mg.kg-1 and fentanyl 10-15 μg·kg^-1.The patients were randomized to receive either rocuronium 0.6 mg·kg^-1 （group R,n=42） or vecuronium 0.1 mg·kg^-1 （group V,n=41） to facilitate tracheal intubation when bispectral index （BIS） value dropped to 60.All data were recorded at the time before anaesthesia （Tb）,loss of consciousness （Ts）,administration of muscle relaxant （Tm）,1 min after administration of muscle relaxant （T1）,when train-of-four stimulation （TOF） reached 0 （T2） and 1,2,3,4,5,7,10 min after tracheal intubation （T3-9）.Results：Heart rate （HR） increased by 17.4%-13.5%,systemic arterial systolic pressure （SAP） increased by 16.94%-14.3%,mean arterial systolic pressure （MAP） increased by 15.1%-13.2% and product of heart rate and arterial systolic pressure（RPP） increased 22.67%-13.96% respectively during 5 minutes after intubation as compared with baseline in group R,which were significantly higher than those in group V during 5 minutes after intubation （P〈0.05）.Conclusion：An intubation dose of rocuronium should be used cautiously in patients with rheumatic heart disease （ASA status Ⅲ-Ⅳ;NYHA classes II-Ⅲ）.

关 键 词：罗库溴铵 维库溴铵 风心病瓣膜置换术 心肌供氧 心肌耗氧 

分 类 号：R614.2[医药卫生—麻醉学] R654.1[医药卫生—外科学]