麻黄碱预处理复合顺式阿曲库铵预注对其起效时间及血流动力学的影响  

The effects of ephedrine following low dose priming with cisatracurium on the onset time of cisatracurium and hemodynamics

作　　者：徐钊[1] 陈林[1] 欧晓峰[1] 郑宏[1] 

机构地区：[1]新疆医科大学第一附属医院麻醉科,新疆乌鲁木齐830011

出　　处：《新疆医科大学学报》2011年第3期283-286,共4页Journal of Xinjiang Medical University

基　　金：新疆维吾尔自治区科技支疆项目(项目编号:200991126)

摘　　要：目的比较麻黄碱预处理复合小剂量顺式阿曲库铵（Cis）预注与两者单独应用对顺式阿曲库铵起效时间及血流动力学的影响。方法 80例择期全麻手术成年患者,美国麻醉医师协会（ASA）Ⅰ~Ⅱ级,随机分为4组（n=20）：对照组（Ⅰ组）,小剂量顺式阿曲库铵预注组（Ⅱ组）,麻黄碱预处理组（Ⅲ组）,麻黄碱预处理复合小剂量顺式阿曲库铵预注组（Ⅳ组）。麻醉诱导：Ⅰ组和Ⅱ组静注异丙酚1~2 mg/kg及生理盐水（2 ml）,Ⅲ组和Ⅳ组静注异丙酚1~2 mg/kg及麻黄碱70μg/kg。待患者入睡校准肌松监测仪后,所有患者静注芬太尼4~5μg/kg,Ⅰ组和Ⅲ组静注生理盐水（2 ml）,Ⅱ组和Ⅳ组预注顺式阿曲库铵0.005 mg/kg。3 min后,Ⅰ组和Ⅲ组静注顺式阿曲库铵0.15 mg/kg,Ⅱ组和Ⅳ组静注顺式阿曲库铵0.145 mg/kg。当T1达最低时由同一麻醉医师行气管插管。记录起效时间（静注插管剂量Cis至T1达最大阻滞的时间）、给予插管剂量Cis前4个成串刺激比率（TOFR）比值及诱导前、插管前即刻、插管后即刻、插管后3 min、插管后5 min的平均动脉压（MAP）、心率（HR）值。结果各组患者间给予插管剂量前TOFR比值差异无统计学意义（P〉0.05）;Ⅳ组插管剂量Cis起效时间短于其它各组（P〈0.05）;Ⅰ组和Ⅱ组插管前MAP、HR较诱导前降低（P〈0.05）,Ⅲ组和Ⅳ组插管前MAP、HR较诱导前降低,差异无统计学意义（P〉0.05）;各组插管后即刻、插管后3 min的MAP、HR与插管前即刻相比均增加（P〈0.05）。结论麻黄碱预处理复合小剂量顺式阿曲库铵预注与两者单独使用相比,可进一步缩短顺式阿曲库铵起效时间及减少不良反应。Objective To compare the effects of cisatracurium priming,ephedrine pretreatment and ephedrine pretreatment combined with cisatracurium priming on the onset time of cisatracurium and hemodynamics.Methods Eighty American society of anesthesiologists（ASA） Ⅰ~Ⅱ adult patients scheduled for elective surgery undergoing general anesthesia were randomly allocated to four groups with 20 cases each group.Group Ⅰ was control group,group Ⅱ was cisatracurium group,group Ⅲ was ephedrine pretreatment group,group Ⅳ was ephedrine pretreatment combined with cisatracurium priming group.Anesthesia induction： all patients were intravenoused（Ⅳ） propofol 1～2 μg/kg,saline 2 ml（Group Ⅰ and Group Ⅱ） or ephedrine 70 μg/kg（Group Ⅲ and Group Ⅳ）.After the patient lost consciousness and calibrated the muscle relaxation monitor（TOF-Watch SX）,Ⅳ fentanyl 4～5 μg/kg,saline 2 ml（Group Ⅰ and Group Ⅲ） or cisatracurium 0.005 mg/kg（Group Ⅱ and Group Ⅳ） were given.After 3 minutes,Ⅳ cisatracurium 0.15 mg/kg（Group Ⅰ and Group Ⅲ） or 0.145 mg/kg（Group Ⅱ and Group Ⅳ） were given.Endotracheal intubation was performed by a blinded investigator immediately after twitch depressed T-1 the maximum.The following variables were recorded： the onset time,TOFR before Ⅳ intubating dose of cisatracurium,mean arterial pressure（MAP） and heart rate（HR） before induction andjust before intubation,immediately after intubation,3 min after intubation and 5 min after intubation.Results TOFR before Ⅳ intubating dose of cisatracurium were similar in four groups（P〉0.05）.The onset time of group Ⅳ was shorter than other groups（P〈0.05）.The MAP and HR just before intubation of Group Ⅰ and Group Ⅱ were lower than before induction（P〈0.05）.The MAP and HR just before intubation of Group Ⅲ and Group Ⅳ were lower than before induction,but the differences were no significances（P〉0.05）.The MAP and HR after intubation immediately,3 minutes of all Groups were higher

关 键 词：顺式阿曲库铵 麻黄碱 血液动力学现象 起效时间 

分 类 号：R614[医药卫生—麻醉学]