丙泊酚与七氟烷诱导对顺式阿曲库铵起效时间的影响  

Effects of intravenous propofol and inhalational sevoflurane on onset time of cisatracurium:a comparative study

作　　者：阳兴[1] 黄漫[1] 王远胜[1] 

机构地区：[1]广东省江门市中心医院麻醉科,529070

出　　处：《上海医学》2010年第8期728-730,共3页Shanghai Medical Journal

摘　　要：目的比较丙泊酚与七氟烷两种麻醉诱导方式对顺式阿曲库铵起效时间的影响。方法选择60例美国麻醉医师学会(ASA)分级Ⅰ～Ⅱ级,择期行手术的全身麻醉患者,年龄18～45岁,随机分为丙泊酚诱导组(P1组和P2组)和七氟烷诱导组(S组),每组20例。采用电刺激尺神经监测拇内收肌肌颤搐反应的方法进行肌松监测。麻醉诱导均采用静脉注射芬太尼4μg/kg,此外,P1组静脉注射丙泊酚1.0mL/kg,P2组静脉注射丙泊酚1.5mL/kg,S组采用肺活量吸入法吸入体积分数为0.08的七氟烷。患者入睡后行肌松监测定标,并继续采用同样条件连续单刺激监测肌松情况。经外周静脉注射顺式阿曲库铵0.2mg/kg(4个95%有效剂量),肌松后行气管插管,同时监测3组患者的意识消失时间、血流动力学变化及顺式阿曲库铵起效时间。结果 P2和S组的意识消失时间均显著短于P1组(P值均<0.01)。所有患者的插管均一次顺利完成。S组的顺式阿曲库铵肌松起效时间均显著短于P1和P2组(P值均<0.01)。P2组诱导后舒张压明显降低,P2组与P1和S组间诱导后插管前即刻舒张压与基础值的差值的差异均有统计学意义(P值均<0.05)。P2和S组插管后即刻与诱导后插管前即刻收缩压和心率的差值均显著小于P1组(P值分别<0.05、0.01),S组插管后即刻与诱导后插管前即刻舒张压的差值均显著小于P1和P2组(P值分别<0.01、0.05)。结论与丙泊酚比较,七氟烷能明显缩短顺式阿曲库铵的起效时间,且血流动力学平稳。Objective To compare the induction quality of intravenous propofol with inhalational sevoflurane and to investigate their effects on the onset time of cisatracurium.Methods Sixty American Society of Anesthesiologists（ASA）Ⅰ-Ⅱ patients,aged from 18 to 45 years,undergoing selective surgery under general anesthesia were randomized into three groups：group P1,P2 and S.Group P：intravenous induction with 1.0 mL/kg propofol,group P2：intravenous induction with 1.5 mL/kg propofol,and group S：inhalation of 0.08 sevoflurane in vital capacity respiration.All patients received intravenous fentanyl（4 μg/kg）for anesthesia induction.The twitch response was stabilized with cisatracurium（0.2 mg/kg,4 ED95）.The time to loss of eyelash reflex,hemodynamic changes,and onset time of cisatracurium were all recorded.Results The time to loss of eyelash reflex in group S and group P2 was significantly shorter than that in group P1（P〈0.01）;but there was no difference between group P2 and group S.All the intubation attempts were successful at the first try.The onset time of cisatracurium in group S was significantly shorter than that in group P1 and group P2（P〈0.01）.The tracheal intubation conditions were similar in three groups.The induction significantly pressed the diastolic blood pressure（DBP）in group P2 compared with group P1and S（P〈0.05）.Moreover,tracheal intubation caused less stress responses in group S than in group P1 and P2（P〈0.01）.Conclusion Compared with propofol,sevoflurane can greatly shorten the onset time of cisatracurium while remaining stable hemodynamics.（Shanghai Med J,2010,33：728-730）

关 键 词：丙泊酚 七氟烷 顺式阿曲库铵 吸入诱导 静脉诱导 

分 类 号：R614[医药卫生—麻醉学]