单次大剂量哌库溴铵用于成人心脏手术的临床研究  

Clinical study on patients with cardiac surgery in a massive dose of pipecuronium during anesthesia

作　　者：李靖怡[1] 程智刚[1] 王云姣[1] 于鹏[2] 陈婵[1] 郭曲练[1] 

机构地区：[1]中南大学湘雅医院麻醉与危重病医学教研室,湖南长沙410008 [2]嘉兴学院附属第二医院麻醉科,浙江嘉兴314000

出　　处：《中国现代医学杂志》2010年第20期3122-3126,共5页China Journal of Modern Medicine

摘　　要：目的研究单次大剂量哌库溴铵用于成人心脏手术的气管插管条件、肌松效应及对循环的影响。方法择期心脏手术患者ASAⅠ、Ⅱ级50例,随机分为Ⅰ组(麻醉诱导时静脉注射哌库溴铵0.12mg/kg)和Ⅱ组(麻醉诱导时静脉注射哌库溴铵0.15mg/kg)。两组患者均采用咪达唑仑、芬太尼、异丙酚和哌库溴铵全凭静脉麻醉。肌松监测仪测量TOF值,并记录术中患者ECG、心率、肱动脉压、鼻咽温、脉搏血氧饱和度、呼气末二氧化碳分压。结果①两组患者插管条件按Fahey's标准评分均为0分;0.12mg/kg组和0.15mg/kg组起效时间分别为(198±25)s和(156±49)s,插管时间分别为(156±40)s和(155±61)s,两组间差异无显著性。②0.12mg/kg组和0.15mg/kg组无反应期分别为(152±49)min和(198±58)min;T125%恢复时间分别为(227±31)min和(198±58)min;T150%恢复时间分别为(297±19)min和(417±50)min;T175%恢复时间分别为(353±16)min和(430±74)min;T195%恢复时间分别为(400±31)min和(457±79)min;TOF25%恢复时间分别为(274±61)min和(348±53)min;TOF50%恢复时间分别为(306±75)min和(383±44)min;TOF75%恢复时间分别为(353±91)min和(403±106)min,上述指标两组间比较差异有显著性(P<0.05)。③0.12mg/kg组和0.15mg/kg组TOF95%恢复时间分别为(389±120)min和(489±52)min;T125%～75%恢复指数分别为(129±41)min和(87±9)min,完全恢复指数分别为(150±24)min和(163±47)min;两组间差异无显著性(P>0.05)。结论单次给予大剂量哌库溴铵可提供良好的诱导插管条件,且可满足成人3h以内心脏手术的肌松要求。Objective To study the effects of a massive dose of pipecuronium on endotracheal intubation conditions, neuromuscular and cardiovascular function in patients with cardiac surgery.MethodsFifty patients with selective cardiac surgery were randomly divided into two groups： GroupⅠ （n =25）, pipecuronium in 0.12 mg/kg via intravenous infusion during anesthesia induction and GroupⅡ （n =25）, pipecuronium in 0.15 mg/kg via intravenous infusion during anesthesia induction. The patients in two groups were received total intravenous anesthesia with mi-dazolam, fentanyl, propofol and pipecuronium. Endotracheal intubation conditions were evaluated. Neuromuscular function and hemodynamics were monitored during anesthesia. ResultsEndotracheal intubation conditions were comparable in two groups. ＂Excellent＂ scores were given to all patients. Mean onset time （time to maximum twitch depression） in group Ⅰand group Ⅱ were （198 ± 25 second） and（9156±49 second）. Mean intubation time in group Ⅰand group Ⅱ were （156 ± 40 second） and（155 ± 61 second）. There was no significant difference between group Ⅰand group Ⅱ in mean onset time and mean intubation time P 0.05. Neuromuscular blockage durations in groupⅠand group Ⅱ were （152 ± 49） min and（198 ± 58）min; Mean T1 25%recovery time in groupⅠand group Ⅱ were （227 ± 31） min and（297 ± 101）min, Mean T1 50%recovery time in groupⅠand group Ⅱ were （297 ± 19） min and （417 ± 50）min; Mean T175%recovery time in groupⅠand group Ⅱ were （353 ± 16 min） and （430 ±74min）; Mean T195%recovery time in groupⅠand group Ⅱ were （400 ±31）min and （457 ± 79）min; Mean TOF25%recovery time in groupⅠand group Ⅱ were （274 ± 61）min and（348±53）min; Mean TOF50%recovery time in groupⅠand group Ⅱ were （306 ± 75）min and （383±44）min; Mean TOF 75% recovery time in groupⅠand group Ⅱ were （353 ± 91）min and （403±106）min; Mean TOF95%recovery time in groupⅠand group Ⅱ

关 键 词：哌库溴铵 肌松药 肌松监测 四个成串刺激 心脏外科 

分 类 号：R614.2[医药卫生—麻醉学]